Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP05967 | LA |
NPI | 1467781757 |
---|---|
Provider Name | Latasha L Johnigan |
First Address | Batchelor, LA 70715 |
Second Address | Innis, LA 70747-0889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2009 |
Last Update Date | 01/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1818682 | (05) | LA |