Individual
MIKQENYA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
201 4TH ST STE 5A, ALEXANDRIA, LA 71301-8421
(318) 512-2804
Mailing address
201 4TH ST STE 5A, ALEXANDRIA, LA 71301-8421
(318) 512-2804
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
207723
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123
—
LA
Enumeration date
10/01/2021
Last updated
10/01/2021
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