Provider Demographics
NPI:1558058545
Name:JOHNSON, SOMERLEIGH BRIIN (APRN - CNP)
Entity Type:Individual
Prefix:
First Name:SOMERLEIGH
Middle Name:BRIIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN - CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4147 E 48TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4740
Mailing Address - Country:US
Mailing Address - Phone:918-557-4216
Mailing Address - Fax:
Practice Address - Street 1:6550 E 71ST ST STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2773
Practice Address - Country:US
Practice Address - Phone:918-480-8707
Practice Address - Fax:918-794-8702
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK212427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily