Individual provider · Type 1 NPI

Justin Bohannan, AG-ACNP

Acute Care Nurse Practitioner · Lake Charles, LA

NPI number 1124695408 Active

Practice location

2770 3rd Ave Ste 350
Lake Charles, LA 70601-0404

Fax (337) 494-2760

Mailing address

PO Box 122309 Dept 2309
Dallas, TX 75312-0001

Specialties and licenses

TaxonomyCodeLicense
Acute Care Nurse Practitioner Primary 363LA2100X219004 (LA)

Acute Care Nurse Practitioner: Definition to come...

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About NPI 1124695408

Justin Bohannan, AG-ACNP's National Provider Identifier is 1124695408, issued on Jun 7, 2021. The primary taxonomy on file is Acute Care Nurse Practitioner (363LA2100X), and the practice location is in Lake Charles, LA. The record was last updated on Feb 3, 2022.