Provider Demographics
NPI:1649760315
Name:JOHNSON, BRALIN
Entity Type:Individual
Prefix:MR
First Name:BRALIN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 NW RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-3743
Mailing Address - Country:US
Mailing Address - Phone:337-831-4282
Mailing Address - Fax:
Practice Address - Street 1:512 NW RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-3743
Practice Address - Country:US
Practice Address - Phone:133-783-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator