Provider Demographics
NPI:1669659660
Name:JOHNSON, ALICIA C (CSA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CSA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 46
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-899-3858
Practice Address - Fax:502-899-3878
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2020-12-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYSA187OtherKENTUCKY MEDICAL LICENSURE
KY2389OtherNAT'L SURGICAL ASST ASSOC
KY86585OtherNAT'L CERT SURG TECH