Provider Demographics
NPI:1588719215
Name:JOHNSON, CHAQUETTA THOMAS (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHAQUETTA
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3604
Mailing Address - Country:US
Mailing Address - Phone:318-448-2447
Mailing Address - Fax:318-487-5338
Practice Address - Street 1:5604A COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3709
Practice Address - Country:US
Practice Address - Phone:318-487-5282
Practice Address - Fax:318-487-5338
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03956363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health