Provider Demographics
NPI:1932836335
Name:JOHNSON, CINDY KAY (RN ADN)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN ADN
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:KAY
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7900
Mailing Address - Country:US
Mailing Address - Phone:405-602-8100
Mailing Address - Fax:
Practice Address - Street 1:2914 QUEENSTON AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-3833
Practice Address - Country:US
Practice Address - Phone:405-973-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0091346163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0091346OtherOKLAHOMA BOARD OF NURSING