Provider Demographics
NPI:1407823180
Name:JOHNSON, TERRI J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:J
Other - Last Name:LATTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4860 COLLEGE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1681
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:4901 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1602
Practice Address - Country:US
Practice Address - Phone:816-478-4200
Practice Address - Fax:816-875-2598
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55447367500000X
KS13-78852-072163W00000X
MO150888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200333130BMedicaid
KS139000040Medicare PIN