Provider Demographics
NPI:1144345935
Name:JOHNSON, JENNIFER NICOLE (CMII)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CMII
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOL
Other - Last Name:FRIZZELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FRIZZELL
Mailing Address - Street 1:2307 GORDON COOPER DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-9007
Mailing Address - Country:US
Mailing Address - Phone:405-214-5101
Mailing Address - Fax:
Practice Address - Street 1:2307 GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9007
Practice Address - Country:US
Practice Address - Phone:405-214-5101
Practice Address - Fax:405-878-5846
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK313526171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator