1265494785 NPI number — MRS. DUSTY JOHNSON CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265494785 NPI number — MRS. DUSTY JOHNSON CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JOHNSON

Provider First Name:

DUSTY

Provider Middle Name:

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

DEVINE

Provider Other First Name:

DUSTY

Provider Other Middle Name:

Provider Other Name Prefix Text:

MISS

Provider Other Name Suffix Text:

Provider Other Credential Text:

CRNA

Provider Other Last Name Type Code:

1

NPI Number:

1265494785

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/25/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

643 RAY LEWIS RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BLAIRSVILLE

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30512-1439

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

706-745-9068

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

35 HOSPITAL RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BLAIRSVILLE

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30512-3139

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-453-1548

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  282190 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: RN514136L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: RN275163 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 104122 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 20053633 . This is a "MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50058155 . This is a "KEYSTONE HEALTH PLAN CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50058155 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 001833846 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7598828 . This is a "AETNA-NON HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P00298903 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2689279000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1278934 . This is a "AETNA-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".