Individual ProviderMariah JohnsonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1720 NE 23rd St, Oklahoma City, OK 73111-3324(405) 280-5550PECOS EnrollmentBased on the most recent information from CMS, provider Mariah Johnson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 7:33 AM.Profile DetailsProvider ID1124796610Provider TypeIndividualFull NameJohnson, MariahTitleDr.CredentialDNP, APRN, FNP-CGenderFemaleSole ProprietorYesEnumeration Date8/31/2021Last Updated4/27/2022Contact InformationPractice LocationPractice Address1720 NE 23rd St, Oklahoma City, OK 73111-3324Phone(405) 280-5550FaxUnlisted FaxMailing LocationMailing Address1720 NE 23rd St, Oklahoma City, OK 73111-3324Phone(405) 280-5550FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense205276Oklahoma