Stephen Johnston, PA
Individual provider Active NPI Physician Assistant · Edmond, OK
NPI 1629337753 · NPPES record last updated Mar 22, 2021
Key facts
- NPI
- 1629337753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2500 (OK)
- Practice address
- 2000 E 15TH St Ste 400a
Edmond, OK 73013-6673 - Phone
- (405) 341-1697
- Fax
- (405) 341-2672
- NPI assigned
- May 9, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-3428 | CO | MD | Medical Physician Assistant |
| PA2500 | OK | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-3428 | CO | |
| Medical Physician Assistant | 363AM0700X | PA2500 | OK | |
| Physician Assistant | 363A00000X | 2500 | OK | Yes |
Addresses
Primary practice location
2000 E 15TH St Ste 400a
Edmond, OK 73013-6673
Mailing address
19632 Stratmore Way
Edmond, OK 73012-2205
Phone (970) 672-6952
Other providers in Edmond, OK
- Tina Diane Johnson
- Verlinda Johnson
- Victoria Johnson
- Zuri Johnson
- Lisa O Johnston
- Sydney Joiner
- Joint Technology Inc
- Jonathan a Doyle PLLC
- Jonathan B Roth LLC
- Aaron Jones
All providers in Edmond, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.