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General NPI Number Information
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NPI Number | 1912546144
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Entity Type | Individual
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Provider Name | MICHELLE JOHNSON APRN
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 1825 PREAKNESS PATH
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City | GUTHRIE
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State | OK
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Zip | 73044-7880
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Country | US
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Telephone | 405-887-3141
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Fax |
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Provider Business Mailing Address
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Address Line | 823 W. LAKEWOOD DR.
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City | GUTHRIE
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State | OK
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Zip | 73044-7880
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Country | US
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Telephone | 405-887-3141
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 82503
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License Number State | OK
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