Provider Demographics
NPI:1912538075
Name:JOHNSON, JONCIA (MED, MPA)
Entity Type:Individual
Prefix:MS
First Name:JONCIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 NW 39TH ST APT 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6373
Mailing Address - Country:US
Mailing Address - Phone:405-323-9657
Mailing Address - Fax:
Practice Address - Street 1:2000 N CLASSEN BLVD STE 2600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6027
Practice Address - Country:US
Practice Address - Phone:405-243-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator