Provider Demographics
NPI:1326504978
Name:JOHNSON, ALYSSA (APRN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17645 WRIGHT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17645 WRIGHT ST STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2195
Practice Address - Country:US
Practice Address - Phone:833-667-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257536363LF0000X
GAGAA-NP000125363LF0000X
IL209022619363LF0000X
MN7637363LF0000X
MI4704366158363LF0000X
MECNP201218363LF0000X
KY3014699363LF0000X
KS53-79541-081363LF0000X
IAA132839363LF0000X
IN71010220C363LF0000X
COC-APN.0002118-C-NP363LF0000X
TXAP138620363LF0000X
NDR49241363LF0000X
MO2020019582363LF0000X
NE112963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily