Provider Demographics
NPI:1891682639
Name:JOHNSON, EARLINE PHYLLIS (RN)
Entity type:Individual
Prefix:
First Name:EARLINE
Middle Name:PHYLLIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EARLINE
Other - Middle Name:PHYLLIS
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2414 E SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1530
Mailing Address - Country:US
Mailing Address - Phone:918-577-3000
Mailing Address - Fax:
Practice Address - Street 1:2414 E SHAWNEE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1530
Practice Address - Country:US
Practice Address - Phone:918-577-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0057976163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health