Provider Demographics
NPI:1568140846
Name:JOHNSON, BETH CHERIE
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:CHERIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854-0008
Mailing Address - Country:US
Mailing Address - Phone:405-374-1225
Mailing Address - Fax:866-201-3530
Practice Address - Street 1:32018 HWY 59-OK
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74764
Practice Address - Country:US
Practice Address - Phone:405-374-1225
Practice Address - Fax:866-201-3530
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist