Individual
MICHELLE AKIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10247
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1624896
—
LA
01
—
5CU17F600
MEDICARE - PTAN
LA
Enumeration date
07/09/2006
Last updated
09/13/2023
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