Provider Demographics
NPI:1972907038
Name:JOHNSON, CASSIE LYNN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 NW 36TH PL
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6346
Mailing Address - Country:US
Mailing Address - Phone:405-406-3887
Mailing Address - Fax:
Practice Address - Street 1:800 NW 9TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7253
Practice Address - Country:US
Practice Address - Phone:405-231-2900
Practice Address - Fax:405-272-4905
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily