Provider Demographics
NPI:1881164945
Name:JOHNSON, DUSTI RAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:DUSTI
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:DUSTI
Other - Middle Name:RAE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1323 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4399
Mailing Address - Country:US
Mailing Address - Phone:405-372-1480
Mailing Address - Fax:
Practice Address - Street 1:1815 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4202
Practice Address - Country:US
Practice Address - Phone:405-372-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily