Provider Demographics
NPI:1104480763
Name:JOHNS, BRANDI LAUREN (DO)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LAUREN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:101 WINSTON WAY STE C&D
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4962
Practice Address - Country:US
Practice Address - Phone:270-465-9400
Practice Address - Fax:270-469-4893
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5098207Q00000X
KYTP961207Q00000X
KY390200000X
KY5345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program