Individual
KEVIN WAYNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4502 E 41ST ST, TULSA, OK 74135-2536
(918) 619-4400
Mailing address
4502 E 41ST ST, TULSA, OK 74135-2536
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0102206028
VA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
0102206028
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2015
Last updated
06/12/2020
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