Provider Demographics
NPI:1659795268
Name:JOHNSON, BECKIE
Entity Type:Individual
Prefix:
First Name:BECKIE
Middle Name:
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 1:30348 WILDHORSE RD
Mailing Address - Street 2:
Mailing Address - City:SHADY POINT
Mailing Address - State:OK
Mailing Address - Zip Code:74956-2211
Mailing Address - Country:US
Mailing Address - Phone:918-635-5906
Mailing Address - Fax:918-658-2180
Practice Address - Street 1:800 MEADOW LANE
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:OK
Practice Address - Zip Code:74940
Practice Address - Country:US
Practice Address - Phone:918-658-2189
Practice Address - Fax:918-658-2180
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator