Provider Demographics
NPI:1235762816
Name:JOHNSON, CYNTHIA GAYLE (APRN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAYLE
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 1:2010 CHESTNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5340
Mailing Address - Country:US
Mailing Address - Phone:479-262-2724
Mailing Address - Fax:479-262-2727
Practice Address - Street 1:4330 SE 29TH ST STE 3018
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3335
Practice Address - Country:US
Practice Address - Phone:405-670-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123788207Q00000X
OK216639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine