Provider Demographics
NPI:1154865384
Name:JOHNSON, BROOKELYN ANNETTE (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:ANNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13100 N WESTERN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1432
Mailing Address - Country:US
Mailing Address - Phone:405-947-6647
Mailing Address - Fax:
Practice Address - Street 1:13100 N WESTERN AVE STE 301
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1432
Practice Address - Country:US
Practice Address - Phone:405-476-6479
Practice Address - Fax:405-948-6647
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant