Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP132739 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP132739 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | TAPN700512 | NV |
NPI | 1093854721 |
---|---|
Provider Name | Brittany Marie Johnson |
First Address | Dallas, TX 75284-6098 |
Second Address | Tyler, TX 75701-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
366924401 | (05) | TX |
75-2616977-042 | TRICARE (01) | TX |
8171MB | BCBS (01) | TX |
P01773738 | RAIL ROAD MEDICARE (01) | TX |