Johnson, Jesse B

Johnson, Jesse B is an individual health care provider with primary practice located at 609 W Maple Ave , Springdale AR 72764-5335. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Johnson, Jesse B can be contacted via phone (479) 751-5711.

Contact Information

Primary practice address
609 W Maple Ave Springdale AR 72764-5335
Phone: (479) 751-5711
Fax: (479) 751-1099
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 621415 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X C001215 Arkansas

Profile Details

NPI number 1619975455
LBN Legal business name Johnson, Jesse B
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2005
Last updated Oct 11th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619975455 NPPES
Texas MEDICAID 002959701
Texas MEDICAID 139829701
Texas Other 83751H
Texas Other 98519

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