Antqualene Lavette Johnson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1103343

Practice address

2260 Glory Loop
BLDG 1260
Fort Polk, LA 71446

Phone

(337) 531-4127

NPI assigned

Apr 25, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335312000000",
    "number": "1720346943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 GLORY LOOP",
            "address_2": "BLDG 1260",
            "city": "FORT POLK",
            "state": "LA",
            "postal_code": "71446",
            "telephone_number": "337-531-4127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 GLORY LOOP",
            "address_2": "BLDG 1260",
            "city": "FORT POLK",
            "state": "LA",
            "postal_code": "71446",
            "telephone_number": "337-531-4127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANTQUALENE",
        "middle_name": "LAVETTE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": "1103343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis Husser, CRNA
• Ibrahim Idoh, DENTAL HYGIENE
• Isaac Aziz Isaiah, MD.
• Paula Jean Jackson, MD
• Zachary Jacob Jackson
• Henry Johnson Jr., PA-C
• Jerri Lea Johnson, LCSW
• Nichelle Antoinette Johnson, R.D, L.D.
• Debra Jones, MD
• Ellen Carol Jones, M.D.

• Medical Physician Assistant in Fort Polk, LA
• Providers in Fort Polk, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.