Provider Demographics
NPI:1740724632
Name:JOHNSON, ESSIE JEWEL
Entity type:Individual
Prefix:MS
First Name:ESSIE
Middle Name:JEWEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ESSIE
Other - Middle Name:JEWEL
Other - Last Name:GIVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3309 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-2839
Mailing Address - Country:US
Mailing Address - Phone:405-602-4217
Mailing Address - Fax:
Practice Address - Street 1:3309 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-2839
Practice Address - Country:US
Practice Address - Phone:405-602-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator