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General NPI Number Information
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NPI Number | 1699357202
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Entity Type | Individual
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Provider Name | DR. ALYSIA NECAIA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 111 MEDICAL CIR
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City | SULPHUR SPRINGS
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State | TX
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Zip | 75482-2138
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Country | US
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Telephone | 903-558-1850
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Fax | 903-335-8941
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Provider Business Mailing Address
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Address Line | 3949 LINDELL BLVD APT 1009
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3251
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Country | US
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Telephone | 214-532-9178
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | V3619
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License Number State | TX
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