Provider Demographics
NPI:1063251106
Name:JOHNSON, ALEXIS (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:NORWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:16614 23RD AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-4535
Mailing Address - Country:US
Mailing Address - Phone:253-320-0224
Mailing Address - Fax:
Practice Address - Street 1:9329 MARTIN WAY E STE N
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5738
Practice Address - Country:US
Practice Address - Phone:360-870-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP616620162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry