Healthcare Provider Details

I. General information

NPI: 1235083791
Provider Name (Legal Business Name): TOTAL VITALITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12832 E RENO AVE
CHOCTAW OK
73020-7607
US

IV. Provider business mailing address

PO BOX 30483
MIDWEST CITY OK
73140-3483
US

V. Phone/Fax

Practice location:
  • Phone: 707-344-0524
  • Fax: 405-754-2199
Mailing address:
  • Phone: 405-754-2199
  • Fax: 405-754-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DYANNA JOHNSTON
Title or Position: OWNER
Credential: NP
Phone: 707-344-0524