=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497623946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIGITTE LAVERN JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2025
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 MERTON MINTER ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5300
-----------------------------------------------------
Fax | 210-949-3318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14122 CHURCHILL ESTATES BLVD APT 704
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78248-1166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5300
-----------------------------------------------------
Fax | 210-949-3318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Registered Nurse
-----------------------------------------------------
License Number | 638593
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------