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General NPI Number Information
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NPI Number | 1861215303
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Entity Type | Individual
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Provider Name | MR. DRAKE VINCENT JOHNSTON
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Gender | Male
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1303 W TECUMSEH RD APT 727
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City | NORMAN
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State | OK
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Zip | 73069-3247
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Country | US
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Telephone | 405-823-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 800 STANTON L YOUNG BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5018
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Country | US
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Telephone | 405-271-2316
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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