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NPI Code Detail

MEDICARE: ALICIA JEAN JOHNSON FNP-C

MEDICARE: ALICIA JEAN JOHNSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician209.034133IL

General Provider Information

NPI Number : 1376406793
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA JEAN JOHNSON FNP-C
Provider Business Mailing Address
First Line : 17295 N SPEEDWAY RD
Second Line :
City : LEWISTOWN
State : IL
Zip : 61542-9446
Country : US
Telephone Number : 309-647-0201
Fax Number :
Provider Business Practice Location Address
First Line : 180 S MAIN ST
Second Line :
City : CANTON
State : IL
Zip : 61520-2608
Country : US
Telephone Number : 309-647-0201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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Directions to “ ALICIA JEAN JOHNSON FNP-C” Practice Location

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