Provider Demographics
NPI:1356039358
Name:JOHNSON, KEYONA
Entity type:Individual
Prefix:MISS
First Name:KEYONA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 N MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-6447
Mailing Address - Country:US
Mailing Address - Phone:918-949-4212
Mailing Address - Fax:918-949-4299
Practice Address - Street 1:3606 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6447
Practice Address - Country:US
Practice Address - Phone:918-949-4212
Practice Address - Fax:918-949-4299
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator