Provider Demographics
NPI:1124180708
Name:JOHNSON, BRIAN KEITH (FNP-C, CRNFA, MSN)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:FNP-C, CRNFA, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21200 S LAGRANGE RD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-2003
Mailing Address - Country:US
Mailing Address - Phone:708-256-0816
Mailing Address - Fax:815-534-5576
Practice Address - Street 1:21200 S LAGRANGE RD
Practice Address - Street 2:SUITE 134
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2003
Practice Address - Country:US
Practice Address - Phone:708-256-0816
Practice Address - Fax:815-534-5576
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-249147163WR0006X
IL209009090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant