Individual
SHANNON L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP, APRN, CNS-RX
Contact information
Practice address
1600 SW 119TH ST, OKLAHOMA CITY, OK 73170-4908
(405) 425-8100
(405) 425-8109
Mailing address
5300 N INDEPENDENCE AVE, STE. 280, OKLAHOMA CITY, OK 73112-5556
(405) 425-8100
(405) 425-8109
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
60090
OK
363LF0000X
Family Nurse Practitioner
Primary
60090
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200030250A
—
OK
Enumeration date
10/05/2005
Last updated
02/05/2016
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