Provider Demographics
NPI:1073204236
Name:JOHNSON, RACHEL ANN (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N WILL ROGERS LOOP W
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-6204
Mailing Address - Country:US
Mailing Address - Phone:918-429-6130
Mailing Address - Fax:
Practice Address - Street 1:12455 E 100TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4674
Practice Address - Country:US
Practice Address - Phone:405-757-7818
Practice Address - Fax:405-703-0645
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK211645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily