Individual
MR. KENYON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2939 CARLTON WAY, OKLAHOMA CITY, OK 73120
(405) 314-8182
Mailing address
2939 CARLTON WAY, OKLAHOMA CITY, OK 73120
(405) 314-8182
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
G083469033
OK
Other
Enumeration date
03/26/2015
Last updated
03/26/2015
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