Provider Demographics
NPI:1053175646
Name:JOHNSON, BRANDI (FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 NARON CIR
Mailing Address - Street 2:
Mailing Address - City:POLLOK
Mailing Address - State:TX
Mailing Address - Zip Code:75969-2953
Mailing Address - Country:US
Mailing Address - Phone:936-404-7771
Mailing Address - Fax:
Practice Address - Street 1:1717 SAYERS ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1137
Practice Address - Country:US
Practice Address - Phone:936-899-5368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily