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JUSTIN BOHANNAN AG-ACNP
NPI 1124695408
Nurse Practitioner - Acute Care in Lake Charles, LA

Active since June 07, 2021
2770 3RD AVE STE 350, LAKE CHARLES, LA 70601(337) 494-2750(337) 494-2760 Get Directions Write a Review

NPPES record last updated: February 3, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 3, 2022, Jun 8, 2021 (2 updates tracked since 2021).

About Justin Bohannan Ag-acnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JUSTIN BOHANNAN AG-ACNP (NPI 1124695408) is an individual acute care provider in Lake Charles, Louisiana, licensed in Louisiana (219004) and active in the NPI registry since June 2021.

NPPES Registry Identity

NPI1124695408
Entity TypeIndividualMale
Primary Taxonomy363LA2100X
Provider Legal NameJUSTIN BOHANNANCredential: AG-ACNP
Location Address2770 3RD AVE STE 350Lake Charles, LA 70601-0404
Mailing AddressPo Box 122309 Dept 2309Dallas, TX 75312-0001 · (337) 494-2772 · Fax (337) 494-2928
Phone(337) 494-2750
Fax(337) 494-2760
Sole ProprietorNo
Enumeration DateJune 7, 2021
Last NPPES UpdateFebruary 3, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 3, 2022
✔ NPI 1124695408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in LA · 219004
2770 3RD AVE STE 350, Lake Charles, LA 70601
Open in Google Maps ↗

Other Identifiers 2

Other219004LA · State License
Medicaid2560891LA

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAKE CHARLES MEDICAL SERVICES INC
Internal Medicine (Pulmonary Disease)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2921
LAURYN CAITLIN LESLIE APRN, FNP-C
Nurse Practitioner (Family)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2750
JENNIFER TAYLOR GRAHAM ANP
Nurse Practitioner (Adult Health)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2750
DR. FIDENCIO HERNAN DAVALOS M.D.
Internal Medicine (Critical Care Medicine)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2750
HALEY ANGELLE LANDRY NP
Nurse Practitioner (Family)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2750
DR. RONALD MOORE LEWIS JR. MD
Internal Medicine
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-6800
ASHLEY WHITE BABINEAUX FNP-C
Nurse Practitioner (Family)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2750
LCMS PULMONARY ASSOCIATES OF SOUTHWEST LOUISIANA
Internal Medicine (Pulmonary Disease)
2770 3RD AVE STE 350
LAKE CHARLES, LA 70601
Calcasieu Parish (337) 494-2750

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Justin Bohannan's NPI number?

The NPI number for Justin Bohannan is 1124695408. It was assigned to this individual provider in the NPPES registry on June 7, 2021.

Where is Justin Bohannan located?

Justin Bohannan practices at 2770 3rd Ave Ste 350, Lake Charles, LA 70601. The listed phone number is (337) 494-2750.

What is Justin Bohannan's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

When was this NPI record last updated?

The NPPES record for Justin Bohannan was last updated on February 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.