Johnson, Kevin Wayne

Johnson, Kevin Wayne is an individual health care provider with primary practice located at 4030 Gilbert Ave Apt 4, Dallas TX 75219-3869. 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, Kevin Wayne can be contacted via phone (214) 526-3905.

Contact Information

Primary practice address
4030 Gilbert Ave Apt 4 Dallas TX 75219-3869
Phone: (214) 526-3905
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 45551 Texas

Profile Details

NPI number 1750388120
LBN Legal business name Johnson, Kevin Wayne
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2005
Last updated May 12th, 2009 - about 15 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 1750388120 NPPES
Texas Other 00C68R BCBSTX
Texas MEDICAID 120052905 BCBSTX

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