Provider Demographics
NPI:1407193378
Name:JOHNSON, BRANDI STONE (MSN, RN, ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:STONE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, RN, ACNP-BC
Other - Prefix:MRS
Other - First Name:BRANDI
Other - Middle Name:STONE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4418
Mailing Address - Country:US
Mailing Address - Phone:209-342-3108
Mailing Address - Fax:
Practice Address - Street 1:1441 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4404
Practice Address - Country:US
Practice Address - Phone:209-342-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS872266363L00000X
CA95011779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner