Individual
KENT ALAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4400 N LINCOLN BLVD, OKLAHOMA CITY, OK 73105-5104
(918) 344-2128
Mailing address
306 MAIN ST # 619, CANON CITY, CO 81212-3732
(918) 344-2128
(918) 642-5639
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
86602
OK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
C-APN.0100511-C-NP
CO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
C.RXN.0100341-C-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200528420A
—
OK
01
—
344359YRHZ
MEDICARE PTAN
OK
Enumeration date
02/10/2014
Last updated
08/22/2024
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