Individual
MICHELE L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1430 TERRACE DR, TULSA, OK 74104
(918) 748-8024
(918) 748-8249
Mailing address
1430 TERRACE DR, TULSA, OK 74104-4626
(918) 748-8024
(918) 748-8249
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
788
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100187280A
—
OK
Enumeration date
05/02/2006
Last updated
05/20/2019
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