Individual
KAILEY ROBERSON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2508 BERT KOUNS INDUSTRIAL LOOP STE 310, SHREVEPORT, LA 71118-3154
(318) 212-5880
Mailing address
6051 ROMA DR APT 508, SHREVEPORT, LA 71105-4670
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
328816
LA
Other
Enumeration date
09/24/2021
Last updated
11/21/2024
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