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NPI Code Detail

MEDICARE: DESHA RENEE JOHNSON PRSS

MEDICARE: DESHA RENEE JOHNSON PRSS
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1336668805
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESHA RENEE JOHNSON PRSS
Provider Business Mailing Address
First Line : 6333 E SKELLY DR
Second Line :
City : TULSA
State : OK
Zip : 74135-6106
Country : US
Telephone Number : 918-565-4093
Fax Number :
Provider Business Practice Location Address
First Line : 401 E BROADWAY CT STE E
Second Line :
City : SAND SPRINGS
State : OK
Zip : 74063-7931
Country : US
Telephone Number : 918-245-5565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2017
Last Update Date : 01/24/2025

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Directions to “ DESHA RENEE JOHNSON PRSS” Practice Location

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