Provider Demographics
NPI:1902318538
Name:DEPOT, JOHNNIE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JOHNNIE
Middle Name:
Last Name:DEPOT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:JOHNNIE
Other - Middle Name:L
Other - Last Name:AIRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:718 E MAIN ST TRLR 23
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5655
Mailing Address - Country:US
Mailing Address - Phone:580-819-1004
Mailing Address - Fax:
Practice Address - Street 1:222 E SHERIDAN AVE STE 2
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4209
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator