Provider Demographics
NPI:1346545480
Name:JOHNSON, BRANDI SUE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 EAST POPLAR
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454
Mailing Address - Country:US
Mailing Address - Phone:870-598-1122
Mailing Address - Fax:870-598-1123
Practice Address - Street 1:318 EAST POPLAR
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454
Practice Address - Country:US
Practice Address - Phone:870-598-1122
Practice Address - Fax:870-598-1123
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator