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General NPI Number Information
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NPI Number | 1669659660
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Entity Type | Individual
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Provider Name | ALICIA C JOHNSON CSA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 3900 KRESGE WAY SUITE 46
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City | LOUISVILLE
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State | KY
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Zip | 40207-4660
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Country | US
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Telephone | 502-899-3858
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Fax | 502-899-3878
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Provider Business Mailing Address
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Address Line | PO BOX 950248
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City | LOUISVILLE
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State | KY
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Zip | 40295-0248
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Country | US
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Telephone | 502-253-1035
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Fax | 502-253-1037
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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