Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin Wayne Johnson, DO

Individual provider Psychiatry Physician · NPI 1104212562

Kevin Wayne Johnson, DO is a Psychiatry in Tulsa, Oklahoma. Graduated from Oklahoma State University College of Osteopathic Medicine in 2015, 11 years ago. Practices with City of Portsmouth, an 8-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
11
Trained at
Oklahoma State University College of Osteopathic Medicine
Licensed in
VA
In the registry since
2015
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

4502 E 41st St
Tulsa, OK 74135-2536
Phone: (918) 619-4400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Child & Adolescent Psychiatry Physician (primary) Taxonomy 2084P0804X · Licence 0102206028 (VA)
Psychiatry Physician Taxonomy 2084P0800X · Licence 0102206028 (VA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1104212562
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 13, 2015
Last updated in NPPESJune 12, 2020
Certification dateJune 12, 2020
Mailing address4502 E 41st St, Tulsa, OK 74135-2536

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolOKLAHOMA STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduated 2015 (11 years in practice)
Group practice City Of Portsmouth — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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