Provider Demographics
NPI:1225235377
Name:JOHNSON, ALICIA D (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:D
Other - Last Name:BREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-515-2260
Mailing Address - Fax:405-307-5617
Practice Address - Street 1:3500 HEALTHPLEX PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9738
Practice Address - Country:US
Practice Address - Phone:405-515-2260
Practice Address - Fax:405-307-5617
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0057581364S00000X
OKR57581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200114010AMedicaid
OK246723202Medicare PIN
OKOKA100708Medicare PIN