Healthcare Provider Details

I. General information

NPI: 1588203897
Provider Name (Legal Business Name): MISS RYLEA ANNE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 36TH AVE NW STE 100&110
NORMAN OK
73072-3251
US

IV. Provider business mailing address

10921 S WESTERN AVE # 110
OKLAHOMA CITY OK
73170-6226
US

V. Phone/Fax

Practice location:
  • Phone: 501-574-3053
  • Fax:
Mailing address:
  • Phone: 405-442-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: