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Individual

JENNIFER LYN JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 762-7561
Mailing address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 762-7561

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
OK

Other

Enumeration date
01/11/2018
Last updated
01/11/2018
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