Individual
JORDAN LEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10983 BIGHORN DR, TYLER, TX 75707-5360
(318) 312-1772
Mailing address
10983 BIGHORN DR, TYLER, TX 75707-5360
(318) 312-1772
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
136156
TX
Other
Enumeration date
07/16/2021
Last updated
07/16/2021
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