Provider Demographics
NPI:1528411485
Name:JOHNSON, DEBRISHA (NP)
Entity Type:Individual
Prefix:
First Name:DEBRISHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 CHETWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5612
Mailing Address - Country:US
Mailing Address - Phone:832-659-0400
Mailing Address - Fax:832-659-0135
Practice Address - Street 1:6910 CHETWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5612
Practice Address - Country:US
Practice Address - Phone:832-659-0400
Practice Address - Fax:832-659-0135
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08924363LF0000X
TXAP131816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily