Individual
JOHNNA PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
17599 S HIGHWAY 88, STABILIZATION CENTER, CLAREMORE, OK 74018-0801
(918) 273-1841
(918) 273-1843
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 273-1841
(918) 273-1843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1854
OK
Other
Enumeration date
10/08/2009
Last updated
01/11/2012
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