Healthcare Provider Details

I. General information

NPI: 1235534165
Provider Name (Legal Business Name): ALEXANDRA LEIGH JOHNSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA LEIGH KOHLER PA

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 R ST 100
LINCOLN NE
68503-3799
US

IV. Provider business mailing address

4545 R ST 100
LINCOLN NE
68503-3799
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-4545
  • Fax: 402-465-3621
Mailing address:
  • Phone: 402-465-4545
  • Fax: 402-465-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1857
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: