Basic Information
Provider Information
NPI: 1649731860
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSTON
FirstName: AFTIN
MiddleName: LOIS
NamePrefix: MRS.
NameSuffix:  
Credential: APRN-CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5300 N INDEPENDENCE AVE STE 280
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731125555
CountryCode: US
TelephoneNumber: 4059493393
FaxNumber: 4059496977
Practice Location
Address1: 3300 NW EXPRESSWAY
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731124418
CountryCode: US
TelephoneNumber: 4059493393
FaxNumber: 4059496977
Other Information
ProviderEnumerationDate: 03/29/2019
LastUpdateDate: 05/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LN0000X92416OKY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal

No ID Information.


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