Healthcare Provider Details

I. General information

NPI: 1578068193
Provider Name (Legal Business Name): BRANDON L JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 E SAHARA AVE
LAS VEGAS NV
89104-3707
US

IV. Provider business mailing address

1810 E SAHARA AVE
LAS VEGAS NV
89104-3707
US

V. Phone/Fax

Practice location:
  • Phone: 832-549-6655
  • Fax: 702-760-1940
Mailing address:
  • Phone: 832-549-6655
  • Fax: 832-549-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: