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NPI Code Detail

MEDICARE: STEPHANIE ROSE JOHNSON

MEDICARE: STEPHANIE ROSE 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
1171M00000XCase Manager/Care Coordinator
2175T00000XPeer Specialist
3172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1528222536
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE ROSE JOHNSON
Provider Business Mailing Address
First Line : 4400 N LINCOLN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-5104
Country : US
Telephone Number : 580-374-4780
Fax Number :
Provider Business Practice Location Address
First Line : 2250 N AIRPORT RD
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-3351
Country : US
Telephone Number : 405-424-7711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2008
Last Update Date : 06/07/2024

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Directions to “ STEPHANIE ROSE JOHNSON ” Practice Location

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