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General NPI Number Information
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NPI Number | 1619975455
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Entity Type | Individual
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Provider Name | JESSE B JOHNSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 609 W MAPLE AVE
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City | SPRINGDALE
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State | AR
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Zip | 72764-5335
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Country | US
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Telephone | 479-751-5711
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Fax | 479-751-1099
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Provider Business Mailing Address
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Address Line | PO BOX 583
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City | LOWELL
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State | AR
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Zip | 72745-0583
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Country | US
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Telephone | 800-475-6236
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Fax | 903-787-5854
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 621415
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | C001215
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License Number State | AR
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