Dylan Johnston
Student in an Organized Health Care Education/Training Program in Tulsa, OK. Individual provider (NPI-1).
Details
- NPI
- 1609594787
- Entity type
- Individual (NPI-1)
- Name
- Dylan Johnston
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 16, 2022
- Certification date
- Aug 16, 2022
- Last updated
- Aug 16, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 363A00000X | Physician Assistant | – | – |
Practice location
1111 W 17th StTulsa, OK 74107-1886
Phone 918-561-1145
Mailing address
17765 W Triplett RdCashion, OK 73016-9694
Phone 405-708-8992
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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