Healthcare Provider Details

I. General information

NPI: 1689534752
Provider Name (Legal Business Name): ANDREA JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

5200 E DANFORTH RD
EDMOND OK
73034-7503
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4700
  • Fax:
Mailing address:
  • Phone: 405-919-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number230256
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: