Individual
MR. PARKER BRANDT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1111 TRINITY LN STE 111, BLOOMINGTON, IL 61704-8112
(309) 663-6461
(309) 663-4529
Mailing address
611 W PARK ST, URBANA, IL 61801-2501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008197
IL
Other
Enumeration date
01/28/2021
Last updated
12/15/2025
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