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Individual
JOHNNY ROLLINS
Active
Individual
JOHNNY ROLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
568457
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208205901
—
TX
01
—
208205902
CSHCN
TX
05
—
208205903
—
TX
01
—
21229808
LOUISIANA MEDICAID
LA
01
—
8Y3011
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/08/2007
Last updated
12/19/2011
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