Provider Demographics
NPI:1497187439
Name:BROTHERS, JOHNNA LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JOHNNA
Middle Name:LEE
Last Name:BROTHERS
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 1:1473 NC 42 43 W
Mailing Address - Street 2:
Mailing Address - City:PINETOPS
Mailing Address - State:NC
Mailing Address - Zip Code:27864-7188
Mailing Address - Country:US
Mailing Address - Phone:252-827-5231
Mailing Address - Fax:
Practice Address - Street 1:1473 NC 42 43 W
Practice Address - Street 2:
Practice Address - City:PINETOPS
Practice Address - State:NC
Practice Address - Zip Code:27864-7188
Practice Address - Country:US
Practice Address - Phone:252-827-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024324363LF0000X
NC5008361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily