Provider Demographics
NPI:1013717370
Name:JOHNSON, ALEXIS DESIRAE
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:DESIRAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12528 GRIFFING AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3042
Mailing Address - Country:US
Mailing Address - Phone:216-254-5036
Mailing Address - Fax:
Practice Address - Street 1:12528 GRIFFING AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-3042
Practice Address - Country:US
Practice Address - Phone:216-254-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health