MEDICARE: LATRESE JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1033065396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRESE JOHNSON

Provider Business Mailing Address
First Line	:	7149 S SANTA FE AVE APT C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-7518
Country	:	US
Telephone Number	:	405-494-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	7149 S SANTA FE AVE APT C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-7518
Country	:	US
Telephone Number	:	405-494-5755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ LATRESE JOHNSON ” Practice Location

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