Individual
MISS NICHELLE ANTOINETTE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D, L.D.
Contact information
Practice address
1585 3RD ST, FORT POLK, LA 71459-5102
(337) 531-3349
Mailing address
1585 3RD ST, FORT POLK, LA 71459-5102
(808) 433-2460
(808) 433-1558
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND 3309
FL
Other
Enumeration date
10/16/2006
Last updated
10/26/2021
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