JUSTIN BOHANNAN AG-ACNP NPI 1124695408

NPI Information

NPI: 1124695408
Provider Name: JUSTIN BOHANNAN, AG-ACNP
Classification: Nurse Practitioner - 363LA2100X
Entity Type: Individual

Specialization: Acute Care

PECOS Registration: Yes

Address:
2770 3RD AVE STE 350
LAKE CHARLES, LA
ZIP 70601
Phone: (337) 494-2750
Get Directions

Justin Bohannan, AG-ACNP is an acute care nurse practitioner in Lake Charles, LA. Justin Bohannan, AG-ACNP NPI is 1124695408. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2770 3RD AVE STE 350
LAKE CHARLES, LA
ZIP 70601-404
Phone: (337) 494-2750
Fax: (337) 494-2760

The NPI 1124695408 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/7/2021 and was last updated on 2/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	219004	LOUISIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	219004	OTHER	LOUISIANA	STATE LICENSE
2	2560891	MEDICAID	LOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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