MEDICARE: SOMERLEIGH BRIIN JOHNSON APRN - CNP

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	363LF0000X	Family Nurse Practitioner	212427	OK

General Provider Information

NPI Number	:	1558058545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMERLEIGH BRIIN JOHNSON APRN - CNP

Provider Business Mailing Address
First Line	:	4147 E 48TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-4740
Country	:	US
Telephone Number	:	918-557-4216
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 E 71ST ST STE 200
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-2773
Country	:	US
Telephone Number	:	918-480-8707
Fax Number	:	918-794-8702

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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