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General NPI Number Information
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NPI Number | 1629337753
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Entity Type | Individual
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Provider Name | STEPHEN JOHNSTON PA
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Gender | Male
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 2000 E 15TH ST STE 400A
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City | EDMOND
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State | OK
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Zip | 73013-6673
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Country | US
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Telephone | 405-341-1697
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Fax | 405-341-2672
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Provider Business Mailing Address
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Address Line | 19632 STRATMORE WAY
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City | EDMOND
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State | OK
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Zip | 73012-2205
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Country | US
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Telephone | 970-672-6952
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-3428
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2500
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2500
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License Number State | OK
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