Bohannan, Justin

Bohannan, Justin is an individual health care provider with primary practice located at 2770 3Rd Ave Ste 350 , Lake Charles LA 70601-0404. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as his primary health care specialty. Bohannan, Justin can be contacted via phone (337) 494-2750.

Contact Information

Primary practice address
2770 3Rd Ave Ste 350 Lake Charles LA 70601-0404
Phone: (337) 494-2750
Fax: (337) 494-2760
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 219004 Louisiana

Profile Details

NPI number 1124695408
LBN Legal business name Bohannan, Justin
Credentials AG-ACNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 7th, 2021
Last updated Feb 3rd, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124695408 NPPES
Louisiana Other 219004 STATE LICENSE
Louisiana MEDICAID 2560891 STATE LICENSE

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