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General NPI Number Information
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NPI Number | 1376406793
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Entity Type | Individual
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Provider Name | ALICIA JEAN JOHNSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 180 S MAIN ST
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City | CANTON
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State | IL
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Zip | 61520-2608
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Country | US
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Telephone | 309-647-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 17295 N SPEEDWAY RD
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City | LEWISTOWN
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State | IL
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Zip | 61542-9446
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Country | US
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Telephone | 309-647-0201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209.034133
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License Number State | IL
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