Provider Demographics
NPI:1316122039
Name:JOHNSTON, MICHELLE LEE (MSN, ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-0660
Mailing Address - Country:US
Mailing Address - Phone:405-373-2400
Mailing Address - Fax:405-373-4400
Practice Address - Street 1:3414 NW 135TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4009
Practice Address - Country:US
Practice Address - Phone:405-749-0900
Practice Address - Fax:405-749-0913
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200187040AMedicaid