Provider Demographics
NPI:1285900605
Name:JOHNSTON, CODY D (CRNA)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:D
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 NE 71ST RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-7407
Mailing Address - Country:US
Mailing Address - Phone:479-739-0149
Mailing Address - Fax:
Practice Address - Street 1:403 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3101
Practice Address - Country:US
Practice Address - Phone:660-747-2500
Practice Address - Fax:660-747-8455
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR89932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered