Provider Demographics
NPI:1134787625
Name:WHITE OAK FAMILY MEDICINE
Entity type:Organization
Organization Name:WHITE OAK FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:430-625-2001
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-0271
Mailing Address - Country:US
Mailing Address - Phone:430-625-2001
Mailing Address - Fax:
Practice Address - Street 1:491 E OLD US HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-2106
Practice Address - Country:US
Practice Address - Phone:430-625-2001
Practice Address - Fax:949-404-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty