Individual
MR. KEVIN WAYNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4030 GILBERT AVE, APT 4, DALLAS, TX 75219-3869
(214) 526-3905
Mailing address
4030 GILBERT AVE, APT 4, DALLAS, TX 75219-3869
(214) 526-3905
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
45551
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C68R
BCBSTX
TX
05
—
120052905
—
TX
Enumeration date
06/30/2005
Last updated
05/12/2009
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