Provider Demographics
NPI:1043224264
Name:JOHNSON, JAY KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KEVIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5310 E 31ST ST FL 13
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5018
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:802 S JACKSON AVE STE 420
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9059
Practice Address - Country:US
Practice Address - Phone:918-743-2882
Practice Address - Fax:918-745-0323
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK369701YM2YOtherMEDICARE
OK100137280BMedicaid
OK100137280AMedicaid
OK130004280OtherRAILROAD MEDICARE
OK130004280OtherRAILROAD MEDICARE
OK$$$$$$$$$001OtherBCBS
OK130004280OtherRAILROAD MEDICARE