Provider Demographics
NPI:1629564182
Name:JOHNSON, ALLYSSA CHRISTINE (APRN, FNP, AGACNP)
Entity Type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, FNP, AGACNP
Other - Prefix:
Other - First Name:ALLYSSA
Other - Middle Name:CHRISTINE
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1642 RICHELIEU LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1835
Mailing Address - Country:US
Mailing Address - Phone:817-437-7926
Mailing Address - Fax:
Practice Address - Street 1:204 W 19TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4077
Practice Address - Country:US
Practice Address - Phone:281-318-1122
Practice Address - Fax:281-946-5564
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily