MEDICARE: LAKESHA 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	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1790463214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHA JOHNSON

Provider Business Mailing Address
First Line	:	815 N 8TH ST
Second Line	:
City	:	SAPULPA
State	:	OK
Zip	:	74066-2201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-8011
Country	:	US
Telephone Number	:	918-428-9540
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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Directions to “ LAKESHA JOHNSON ” Practice Location

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