Individual
JOHNATHAN AUGUSTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5920 COLISEUM BLVD, ALEXANDRIA, LA 71303-3714
(318) 443-9339
(318) 443-9116
Mailing address
151 LAURAS LN, MARKSVILLE, LA 71351-3960
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP09511
LA
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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