MEDICARE: DR. NICOLE ALEXIS JOHNSON M.D.

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
1	207R00000X	Internal Medicine Physician	R7490	TX

General Provider Information

NPI Number	:	1902288020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE ALEXIS JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:	214-645-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 W CAMP WISDOM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2515
Country	:	US
Telephone Number	:	214-645-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	01/06/2025

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