Healthcare Provider Details

I. General information

NPI: 1457717928
Provider Name (Legal Business Name): DYANNA JOHNSTON APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

PO BOX 30483
MIDWEST CITY OK
73140-3483
US

V. Phone/Fax

Practice location:
  • Phone: 572-206-6152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR0095313
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: