MEDICARE: BROOKELYN ANNETTE JOHNSON PA-C

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	363A00000X	Physician Assistant		OK

General Provider Information

NPI Number	:	1154865384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKELYN ANNETTE JOHNSON PA-C

Provider Business Mailing Address
First Line	:	13100 N WESTERN AVE STE 301
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-1432
Country	:	US
Telephone Number	:	405-947-6647
Fax Number	:

Provider Business Practice Location Address
First Line	:	13100 N WESTERN AVE STE 301
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-1432
Country	:	US
Telephone Number	:	405-476-6479
Fax Number	:	405-948-6647

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	06/12/2025

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