Individual
MS. JACLYN MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7777 HENNESSY BLVD STE 2003B, BATON ROUGE, LA 70808-4300
(337) 534-0952
Mailing address
7777 HENNESSY BLVD STE 2003B, BATON ROUGE, LA 70808-4300
(337) 534-0952
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
332573
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Enumeration date
05/27/2022
Last updated
07/18/2022
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