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General NPI Number Information
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NPI Number | 1457172058
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Entity Type | Individual
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Provider Name | MR. CEDRICK JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1311 N LOTTIE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73117-2051
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Country | US
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Telephone | 405-600-3074
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Fax | 405-605-8120
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Provider Business Mailing Address
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Address Line | 812 NW 143RD ST
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City | EDMOND
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State | OK
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Zip | 73013-1926
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Country | US
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Telephone | 405-820-2072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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