1114351202 NPI number — ALEXANDRIA DANIELLE JOHNSON FNP

Table of content: ALEXANDRIA DANIELLE JOHNSON FNP (NPI 1114351202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114351202 NPI number — ALEXANDRIA DANIELLE JOHNSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ALEXANDRIA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114351202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26426-0392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-782-2000
Provider Business Mailing Address Fax Number:
304-782-3102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2373 W. MAIN ST.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-782-2000
Provider Business Practice Location Address Fax Number:
304-782-3102
Provider Enumeration Date:
08/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN80021NP , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN80021NP , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: APRN80021NP . This is a "LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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