Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Justin Bohannan, AG-ACNP

Individual provider Acute Care Nurse Practitioner · NPI 1124695408

Justin Bohannan, AG-ACNP is an Acute Care Nurse Practitioner in Lake Charles, Louisiana. Licensed in Louisiana. Registered with an NPI since 2021.

Licensed in
LA
In the registry since
2021

Practice location Address checks out

2770 3rd Ave Ste 350
Lake Charles, LA 70601-0404
Phone: (337) 494-2750
Fax: (337) 494-2760
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 219004 (LA)

Record details

NPI number1124695408
Entity typeIndividual (Type 1)
GenderMale
Credentials AG-ACNP
Sole proprietorNo
NPI enumeratedJune 7, 2021
Last updated in NPPESFebruary 3, 2022
Certification dateFebruary 3, 2022

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