Healthcare Provider Details

I. General information

NPI: 1902266521
Provider Name (Legal Business Name): AUDRIE PAYTON JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AUDRIE PAYTON MURPHY

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 CAMBELL ST.
WARNER OK
74469
US

IV. Provider business mailing address

2310 W BROADWAY ST.
MUSKOGEE OK
74401
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-7210
  • Fax: 918-463-2585
Mailing address:
  • Phone: 918-682-7210
  • Fax: 918-463-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21044
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8628
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: