Healthcare Provider Details

I. General information

NPI: 1164200176
Provider Name (Legal Business Name): DEBRIKA JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3062 SASANQUA CIR W
SEMMES AL
36575-8310
US

IV. Provider business mailing address

3062 SASANQUA CIR W
SEMMES AL
36575-8310
US

V. Phone/Fax

Practice location:
  • Phone: 251-648-0388
  • Fax:
Mailing address:
  • Phone: 251-648-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-172279
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: