Provider Demographics
NPI:1588225916
Name:MONTYA, JOHNNY CLINTON III (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:CLINTON
Last Name:MONTYA
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:707 HIGHLANDER BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4319
Practice Address - Country:US
Practice Address - Phone:817-583-7100
Practice Address - Fax:817-583-7101
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX778979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered