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General NPI Number Information
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NPI Number | 1932416328
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Entity Type | Individual
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Provider Name | JACQUELINE BALLEW JOHNSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 619 NW 23RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-1415
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Country | US
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Telephone | 405-528-0221
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Fax | 405-528-1517
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Provider Business Mailing Address
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Address Line | 908 NW 18TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6415
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Country | US
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Telephone | 405-525-9080
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ROO68670
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License Number State | OK
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