Provider Demographics
NPI:1992101893
Name:JOHNSON, ANTHONY EARL
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:EARL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:EARL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OWNER
Mailing Address - Street 1:121 N GREENWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-1444
Mailing Address - Country:US
Mailing Address - Phone:918-425-0221
Mailing Address - Fax:918-425-0222
Practice Address - Street 1:121 N GREENWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1444
Practice Address - Country:US
Practice Address - Phone:918-425-0221
Practice Address - Fax:918-425-0222
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0075294163WH0200X
OK37V257521203374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide