Provider Demographics
NPI:1437553252
Name:JOHNSON, ADA DIANN (APRN-BC)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:DIANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9600 BROADWAY EXT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7408
Mailing Address - Country:US
Mailing Address - Phone:405-230-9000
Mailing Address - Fax:405-230-9175
Practice Address - Street 1:5050 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:405-230-9000
Practice Address - Fax:405-230-9157
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2019-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK57970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily