Individual
ALICIA C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSA
Contact information
Practice address
3900 KRESGE WAY, SUITE 46, LOUISVILLE, KY 40207-4660
(502) 899-3858
(502) 899-3878
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 253-1035
(502) 253-1037
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2389
NAT'L SURGICAL ASST ASSOC
KY
01
—
86585
NAT'L CERT SURG TECH
KY
01
—
SA187
KENTUCKY MEDICAL LICENSURE
KY
Enumeration date
01/22/2008
Last updated
12/04/2020
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