Provider Demographics
NPI:1982194858
Name:JOHNSON BROWN, VIVIENE PATRICIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VIVIENE
Middle Name:PATRICIA
Last Name:JOHNSON BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:VIVIENE
Other - Middle Name:JOHNSON
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5935
Mailing Address - Fax:
Practice Address - Street 1:7700 E FLORENTINE RD STE 101
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2245
Practice Address - Country:US
Practice Address - Phone:928-442-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218737363LF0000X, 363LP2300X
AZ273602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ273602OtherSTATE MEDICAL BOARD
TXF07171554OtherFAMILY NURSE PRACTITIONER
GARN218737OtherADVANCE PRACTICE NURSE
AZ124887Medicaid
AZMJ5315393OtherUS DRUG ENFORCEMENT ADMINISTRATION