Provider Demographics
NPI:1407392558
Name:JOHNSON, BRILEE
Entity type:Individual
Prefix:
First Name:BRILEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
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 680256
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-1603
Mailing Address - Country:US
Mailing Address - Phone:256-979-1250
Mailing Address - Fax:256-979-1251
Practice Address - Street 1:212 AIRPORT ROAD W
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968
Practice Address - Country:US
Practice Address - Phone:256-979-1250
Practice Address - Fax:256-979-1251
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant