Active NPI
Pamela Sue Johnson, RN
- Registered Nurse
- Grove, OK
National Provider Identifier
1255790002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R0079207
- Practice address
- 1115 Harbor Rd
Grove, OK 74344-3505 - Phone
- (918) 786-4434
- NPI assigned
- Feb 22, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R0079207 | OK | Primary |
Addresses
Primary practice location
1115 Harbor Rd
Grove, OK 74344-3505
Mailing address
1115 Harber Road
Grove, OK 74344
Phone (918) 786-4434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0079207 | OK | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand Lake Mental Health Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Tulsa, OK
- NPI 1356048656
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456099200000",
"number": "1255790002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 HARBER ROAD",
"city": "GROVE",
"state": "OK",
"postal_code": "74344",
"telephone_number": "918-786-4434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 HARBOR RD",
"city": "GROVE",
"state": "OK",
"postal_code": "743443505",
"telephone_number": "918-786-4434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PAMELA",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-22",
"last_updated": "2016-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OK",
"license": "R0079207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grove, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.