1982194858 NPI number — VIVIENE PATRICIA JOHNSON BROWN FNP-C

Table of content: VIVIENE PATRICIA JOHNSON BROWN FNP-C (NPI 1982194858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982194858 NPI number — VIVIENE PATRICIA JOHNSON BROWN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON BROWN
Provider First Name:
VIVIENE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
VIVIENE
Provider Other Middle Name:
JOHNSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982194858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86304-0880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-759-5935
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 E FLORENTINE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314-2245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-442-8710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN218737 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: RN218737 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 273602 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 273602 . This is a "STATE MEDICAL BOARD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: F07171554 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: RN218737 . This is a "ADVANCE PRACTICE NURSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 124887 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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