KEVIN WAYNE JOHNSON DO
NPI 1104212562
Psychiatry & Neurology - Child & Adolescent Psychiatry in Tulsa, OK

Q: What is the provider's specialty?

The provider's specialty is Psychiatry & Neurology with taxonomy code 2084P0804X and a focus in Child & Adolescent Psychiatry.

Active since April 13, 2015PECOS EnrolledAccepts Medicare Assignment

4502 E 41ST ST, TULSA, OK 74135(918) 619-4400 Get Directions Write a Review

NPPES record last updated: June 12, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Kevin Wayne Johnson Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEVIN WAYNE JOHNSON DO (NPI 1104212562) is an individual child & adolescent psychiatry provider in Tulsa, Oklahoma, licensed in Virginia (0102206028) and active in the NPI registry since April 2015. He is enrolled in Medicare PECOS and is a graduate of Oklahoma State University College Of Osteopathic Medicine (2015).

NPPES Registry Identity

NPI1104212562

Entity TypeIndividualMale

Primary Taxonomy2084P0804X

Provider Legal NameKEVIN WAYNE JOHNSONCredential: DO

Location Address4502 E 41ST STTulsa, OK 74135-2536

Mailing Address4502 E 41st StTulsa, OK 74135-2536

Phone(918) 619-4400

Sole ProprietorNo

Medical School CMSOklahoma State University College Of Osteopathic MedicineGraduated 2015

Enumeration DateApril 13, 2015

Last NPPES UpdateJune 12, 2020

NPPES CertifiedJune 12, 2020

✔ NPI 1104212562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0804X

License✔ Licensed in VA · 0102206028

Definition

Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 0102206028 (VA)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

4502 E 41ST ST, Tulsa, OK 74135

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kevin Wayne Johnson Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7719256601

PECOS Enrollment IDI20200625002722

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.