Healthcare Provider Details

I. General information

NPI: 1841136173
Provider Name (Legal Business Name): TASHEIANA DANIELLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 E 30TH ST
TULSA OK
74129-6260
US

IV. Provider business mailing address

7310 E 30TH ST
TULSA OK
74129-6260
US

V. Phone/Fax

Practice location:
  • Phone: 918-361-5713
  • Fax:
Mailing address:
  • Phone: 918-986-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: