Individual
MR. JERMAINE ANTONIO JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
3341 YOUREE DR STE 205, SHREVEPORT, LA 71105-2149
(318) 219-4167
Mailing address
8932 JEWELLA AVE STE A, SHREVEPORT, LA 71118-2117
(318) 219-4167
(318) 415-0300
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
203158
LA
163WP0808X
Psychiatric/Mental Health Registered Nurse
203158
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
203158
LA
Other
Enumeration date
06/25/2019
Last updated
07/30/2024
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