Healthcare Provider Details

I. General information

NPI: 1962493601
Provider Name (Legal Business Name): ROY STEVEN JOHNSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N PINE RD
OLLA LA
71465-4804
US

IV. Provider business mailing address

148 RONALD BLVD
LAFAYETTE LA
70503-2738
US

V. Phone/Fax

Practice location:
  • Phone: 318-495-3131
  • Fax: 318-495-0749
Mailing address:
  • Phone: 337-852-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number035542
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: