Illisia Marie Johnston, NP-C
NPI #1003486556 in Laurel, Mississippi
Provider Information
- NPI Number
- 1003486556
- Entity Type
- Individual
- Name
- Illisia Marie Johnston, NP-C
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Nurse Practitioner - Family
- Credential
- NP-C
- Enumeration Date
- Jun 28, 2021
- Last Updated
- Oct 3, 2024
Practice Location
- Address
- 1008 N 15TH AVE
- City
- Laurel
- State
- Mississippi
- ZIP Code
- 39440-2656
- Phone
- (601) 426-5125
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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