Provider Demographics
NPI:1598266454
Name:JOHNSON, ALEXI JORDAN (DO)
Entity type:Individual
Prefix:
First Name:ALEXI
Middle Name:JORDAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALEXI
Other - Middle Name:JORDAN
Other - Last Name:SHEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 N THIRD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1594
Mailing Address - Country:US
Mailing Address - Phone:208-263-1435
Mailing Address - Fax:
Practice Address - Street 1:606 N THIRD AVE STE 101
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1594
Practice Address - Country:US
Practice Address - Phone:208-263-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5371141207Q00000X
LA335066208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2524003Medicaid