Individual
BRENDA L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
801 W INTERSTATE 20 STE 132, ARLINGTON, TX 76017-5851
(682) 274-8181
(817) 764-0175
Mailing address
801 W INTERSTATE 20 STE 132, ARLINGTON, TX 76017-5851
(682) 274-8181
(817) 764-0175
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05858
TX
363AS0400X
Surgical Physician Assistant
PA05858
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297908003
—
TX
05
—
297908005
—
TX
01
—
8100NR
BCBS
TX
Enumeration date
09/26/2008
Last updated
10/12/2022
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