Individual
MRS. JACQUELINE BALLEW JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
619 NW 23RD ST, OKLAHOMA CITY, OK 73103-1415
(405) 528-0221
(405) 528-1517
Mailing address
908 NW 18TH ST, OKLAHOMA CITY, OK 73106-6415
(405) 525-9080
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ROO68670
OK
Other
Enumeration date
09/07/2010
Last updated
09/07/2010
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