MEDICARE: TEMPEST JOHANN JOHNSON CPRSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1841542859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMPEST JOHANN JOHNSON CPRSS

Provider Business Mailing Address
First Line	:	1210 SW 77TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2439
Country	:	US
Telephone Number	:	405-774-3772
Fax Number	:	405-601-1183

Provider Business Practice Location Address
First Line	:	1210 SW 77TH TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-2439
Country	:	US
Telephone Number	:	405-774-3772
Fax Number	:	405-601-1183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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