Provider Demographics
NPI:1386285781
Name:TURNER-JOHNSON, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TURNER-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:TURNER- JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18643 LAKE HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5280
Mailing Address - Country:US
Mailing Address - Phone:225-402-5222
Mailing Address - Fax:
Practice Address - Street 1:11017 PERKINS RD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-3007
Practice Address - Country:US
Practice Address - Phone:225-444-5611
Practice Address - Fax:225-444-5788
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2552643Medicaid
LA2552741Medicaid
LA2552651Medicaid
LA2552678Medicaid