Provider Demographics
NPI:1932162575
Name:JOHNSON, JIMMIE II (CRNA)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:
Last Name:JOHNSON
Suffix:II
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 1:501 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3779
Mailing Address - Country:US
Mailing Address - Phone:254-338-5473
Mailing Address - Fax:254-613-4064
Practice Address - Street 1:501 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3779
Practice Address - Country:US
Practice Address - Phone:254-338-5473
Practice Address - Fax:254-613-4064
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684289367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP94379Medicare UPIN