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General NPI Number Information
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NPI Number | 1447232095
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Entity Type | Individual
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Provider Name | SAMMY B JOHNSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3323 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-6977
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Country | US
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Telephone | 936-544-4255
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Fax | 936-544-4409
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Provider Business Mailing Address
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Address Line | 17133 FM 832
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City | BUFFALO
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State | TX
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Zip | 75831-6211
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Country | US
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Telephone | 936-544-4255
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Fax | 936-544-4409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 238328
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License Number State | TX
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