Individual
CAROL COLENE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
701 CEDAR LAKE BLVD STE 120, OKLAHOMA CITY, OK 73114-7815
(405) 445-1210
Mailing address
7780 NS 3570 RD, PRAGUE, OK 74864-9238
(203) 561-7122
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
210538
OK
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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