=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801039672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWNA HERRON JOHNSON, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2009
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 SOUTH A AVENUE
-----------------------------------------------------
City | OILTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74052-0520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-862-3700
-----------------------------------------------------
Fax | 918-862-3703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 520 607 SOUTH A AVENUE
-----------------------------------------------------
City | OILTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74052-0520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-862-3700
-----------------------------------------------------
Fax | 918-862-3703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAWNA M HERRON-JOHNSON
-----------------------------------------------------
Credential | MS, ARNP. P.C.
-----------------------------------------------------
Telephone | 918-865-7936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | R0062363
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------