MEDICARE: MRS. DUSTY LYNN JOHNSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN275163	GA
2	367500000X	Certified Registered Nurse Anesthetist	RN514136L	PA
3	367500000X	Certified Registered Nurse Anesthetist	282190	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00298903	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104122	OTHER	PA	GEISINGER
2	20053633	OTHER	PA	MERCY
3	50058155	OTHER	PA	KEYSTONE HEALTH PLAN CENTRAL
4	50058155	OTHER	PA	CAPITAL BLUE CROSS
5	001833846	OTHER	PA	HIGHMARK
6	7598828	OTHER	PA	AETNA-NON HMO
8	2689279000	OTHER	PA	INDEPENDENCE BLUE CROSS
9	1278934	OTHER	PA	AETNA-HMO

General Provider Information

NPI Number	:	1265494785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DUSTY LYNN JOHNSON CRNA

Provider Business Mailing Address
First Line	:	643 RAY LEWIS RD
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-1439
Country	:	US
Telephone Number	:	706-745-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 HOSPITAL RD
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3139
Country	:	US
Telephone Number	:	610-453-1548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	10/16/2025

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