Mark Brockbank Johnson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

90512 Issued in OK

Practice address

1120 S Utica Ave
Tulsa, OK 74104-4012

Phone

(918) 579-1000

NPI assigned

Oct 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193011200000",
    "number": "1861681389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9188",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756089188",
            "telephone_number": "903-663-3600",
            "fax_number": "903-663-3629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-579-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "BROCKBANK",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-22",
        "last_updated": "2007-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "90512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lyndsey Nikohl Johnson
• Lynetria M Johnson, BHRS
• Marcus Darren Johnson II
• Marjorie Joyce Johnson, LPN
• Mark Johnson, D.O.
• Mashelle Johnson
• Meagan Johnson
• Megan Johnson, PT
• Memory Johnson, PT
• Mercedea Johnson

• Certified Registered Nurse Anesthetist in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Certified Registered Nurse Anesthetist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.