Provider Demographics
NPI:1982214813
Name:JOHNSON, BRANDON LAWRENCE (AGACNP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LAWRENCE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2065
Mailing Address - Country:US
Mailing Address - Phone:434-258-4360
Mailing Address - Fax:
Practice Address - Street 1:1300 E MARSHALL ST FL 10
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5028
Practice Address - Country:US
Practice Address - Phone:804-828-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179817363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care