Provider Demographics
NPI:1295552438
Name:JOHNSON, KARIS (CPM, LM)
Entity type:Individual
Prefix:
First Name:KARIS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8219
Mailing Address - Country:US
Mailing Address - Phone:918-845-6323
Mailing Address - Fax:
Practice Address - Street 1:3000 N 13TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8219
Practice Address - Country:US
Practice Address - Phone:918-845-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99572176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife