Healthcare Provider Details

I. General information

NPI: 1164343596
Provider Name (Legal Business Name): KASEE DAWN ANN JOHNSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N FAIRLAND ST
PRYOR OK
74361-4205
US

IV. Provider business mailing address

114 S KENNEDY ST
VINITA OK
74301-7541
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-1404
  • Fax:
Mailing address:
  • Phone: 918-301-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL0071134
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: