Provider Demographics
NPI:1740674894
Name:JOHNSON, DAVID K (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 MONTGOMERY BLVD NE STE 6
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1291
Mailing Address - Country:US
Mailing Address - Phone:505-308-3145
Mailing Address - Fax:505-308-3147
Practice Address - Street 1:4520 MONTGOMERY BLVD NE STE 6
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1291
Practice Address - Country:US
Practice Address - Phone:505-308-3145
Practice Address - Fax:505-308-3147
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668015163W00000X
NMCRNA-01467367500000X
TXAP128885367500000X
VA0024184236367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse