Individual
KYLE ERICK JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2929 S GARNETT RD, C/O MEDCENTER, TULSA, OK 74129-5101
(918) 665-1520
(405) 749-4561
Mailing address
PO BOX 22063, DEPT 0289, TULSA, OK 74121-2063
(405) 751-4664
(405) 749-4561
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1250
OK
Other
Enumeration date
05/01/2006
Last updated
07/08/2007
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