=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962493601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROY STEVEN JOHNSON CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2005
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1102 N PINE RD
-----------------------------------------------------
City | OLLA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71465-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-495-3131
-----------------------------------------------------
Fax | 318-495-0749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 RONALD BLVD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-852-3160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 035542
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------