Provider Demographics
NPI:1730861683
Name:JOHNSON, BRAIDEE (APRN- CNP)
Entity type:Individual
Prefix:MRS
First Name:BRAIDEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN- CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4991 DUMFRIES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4229
Mailing Address - Country:US
Mailing Address - Phone:512-997-8637
Mailing Address - Fax:
Practice Address - Street 1:2800 KIRBY DR # 224
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1273
Practice Address - Country:US
Practice Address - Phone:713-559-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX863941163WE0003X
TX1129247363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency