Healthcare Provider Details

I. General information

NPI: 1053150136
Provider Name (Legal Business Name): CHELSEA NICOLE JOHNSON FSP 2
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E MAIN ST
NORMAN OK
73071-5300
US

IV. Provider business mailing address

4400 W MAIN ST TRLR 82
NORMAN OK
73072-4499
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-5100
  • Fax:
Mailing address:
  • Phone: 405-343-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: