MEDICARE: CAMERON JOHNSON CRNA, DNP

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	163W00000X	Registered Nurse	1162642	KY
2	367500000X	Certified Registered Nurse Anesthetist	4058263	KY

General Provider Information

NPI Number	:	1467230615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON JOHNSON CRNA, DNP

Provider Business Mailing Address
First Line	:	130 BEAVER DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8901
Country	:	US
Telephone Number	:	859-582-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 BEAVER DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8901
Country	:	US
Telephone Number	:	859-582-0406
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	06/01/2026

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