Provider Demographics
NPI:1447388699
Name:JOHNSON, ALICIA G (RN)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:JANE
Other - Last Name:GIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-445-7787
Mailing Address - Fax:512-440-4059
Practice Address - Street 1:56 EAST AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4323
Practice Address - Country:US
Practice Address - Phone:512-804-3481
Practice Address - Fax:512-804-3479
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582525163WP0807X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult