Individual
MARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
307 HAYES ST, RAYVILLE, LA 71269-2531
(318) 728-5488
Mailing address
307 HAYES ST, RAYVILLE, LA 71269-2531
(318) 728-5488
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
208805
LA
Other
Enumeration date
05/29/2020
Last updated
05/29/2020
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