Individual
LAURIE G JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6501 E 2ND ST, CASPER, WY 82609-4293
(307) 235-5433
Mailing address
104 WOODMONT BLVD STE 500, NASHVILLE, TN 37205-2245
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
228
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311524
BLUE SHIELD
WY
01
—
82601D033
WPS TRIWEST
WY
Enumeration date
08/01/2006
Last updated
10/12/2021
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