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General NPI Number Information
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NPI Number | 1497271415
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Entity Type | Individual
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Provider Name | BRANDI DAVIS JOHNSTON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1200 NORTH STATE STREET SUITE 420
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City | JACKSON
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State | MS
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Zip | 39202
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Country | US
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Telephone | 601-355-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 103
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City | MEMPHIS
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State | TN
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Zip | 38120-9446
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Country | US
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Telephone | 901-227-3255
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Fax | 901-227-3205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 902163
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 902163
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 902163
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License Number State | MS
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