MEDICARE: MR. ANTHONY EARL 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	163WH0200X	Home Health Registered Nurse	R 0075294	OK
2	374U00000X	Home Health Aide	37V257521203	OK

General Provider Information

NPI Number	:	1992101893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY EARL JOHNSON

Provider Business Mailing Address
First Line	:	121 N GREENWOOD AVE
Second Line	:	SUITE B
City	:	TULSA
State	:	OK
Zip	:	74120-1444
Country	:	US
Telephone Number	:	918-425-0221
Fax Number	:	918-425-0222

Provider Business Practice Location Address
First Line	:	121 N GREENWOOD AVE
Second Line	:	SUITE B
City	:	TULSA
State	:	OK
Zip	:	74120-1444
Country	:	US
Telephone Number	:	918-425-0221
Fax Number	:	918-425-0222

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/09/2014

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