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

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LA2100X and a focus in Acute Care.

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: July 19, 2026.

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

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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

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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)