Provider Demographics
NPI:1629842265
Name:JOHNSON, BRANDY NICOLE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE
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 1:3051 W CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3917
Mailing Address - Country:US
Mailing Address - Phone:409-259-9323
Mailing Address - Fax:
Practice Address - Street 1:3051 W CROCKETT ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3917
Practice Address - Country:US
Practice Address - Phone:409-259-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372500000X, 372600000X, 373H00000X, 374T00000X, 3747A0650X, 3747P1801X, 376K00000X, 374U00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide