Individual
JENNIFER EVETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
605 S 1ST ST, MADILL, OK 73446-3807
(580) 795-3794
Mailing address
605 S 1ST ST, MADILL, OK 73446-3807
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
08/24/2021
Last updated
09/10/2021
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