Individual
MR. RANDALL SILVEN JOHNSTON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A-GNP-C
Contact information
Practice address
2890 DOUGLAS DR # 100, BOSSIER CITY, LA 71111-5806
(318) 742-6900
Mailing address
1333 COATES BLUFF DR APT 1525, SHREVEPORT, LA 71104-2800
(318) 229-8539
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
202864
LA
363LG0600X
Gerontology Nurse Practitioner
202864
LA
363LP2300X
Primary Care Nurse Practitioner
Primary
202864
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202864
LOUISIANA STATE BOARD OF NURSING
LA
01
—
AG05220099
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
—
Enumeration date
07/21/2022
Last updated
09/15/2022
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