Individual
JESSE B JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
609 W MAPLE AVE, SPRINGDALE, AR 72764-5335
(479) 751-5711
(479) 751-1099
Mailing address
PO BOX 583, LOWELL, AR 72745-0583
(800) 475-6236
(903) 787-5854
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
621415
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
C001215
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002959701
—
TX
05
—
139829701
—
AR
01
—
83751H
BLUE CROSS
TX
01
—
98519
BLUE CROSS
AR
Enumeration date
07/13/2005
Last updated
10/30/2024
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