Most Relevant Information
Provider Data
| NPI Number: | 1003324021 |
| Provider Name: | JENNIFER LYN JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/11/2018 |
| Last Updated: | 01/11/2018 |
Provider Practice Location
1500 N 6TH ST
PONCA CITY
OK
746012827
Practice Location Phone/Fax
| Phone: | 5807627561 |
| Fax: |
Provider Mailing Location
1500 N 6TH ST
PONCA CITY
OK
746012827
Provider Mailing Phone/Fax
| Phone: | 5807627561 |
| Fax: |