MEDICARE: MRS. BRAIDEE JOHNSON APRN- CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	863941	TX
2	363L00000X	Nurse Practitioner	1129247	TX

General Provider Information

NPI Number	:	1730861683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRAIDEE JOHNSON APRN- CNP

Provider Business Mailing Address
First Line	:	4991 DUMFRIES DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4229
Country	:	US
Telephone Number	:	512-997-8637
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 KIRBY DR # 224
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-1273
Country	:	US
Telephone Number	:	713-559-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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