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General NPI Number Information
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NPI Number | 1730801416
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Entity Type | Individual
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Provider Name | JAKE HENRY JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3750 W MAIN ST STE AA
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City | NORMAN
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State | OK
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Zip | 73072-4645
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Country | US
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Telephone | 405-928-9438
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 W MAIN ST STE AA
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City | NORMAN
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State | OK
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Zip | 73072-4645
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Country | US
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Telephone | 480-290-4385
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 40389
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License Number State | OK
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