Provider Demographics
NPI:1215787601
Name:JOHNSON, ALEXANDREA LYN
Entity type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 TWIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7381
Mailing Address - Country:US
Mailing Address - Phone:740-297-0765
Mailing Address - Fax:
Practice Address - Street 1:1225 WOODLAWN AVE STE 114
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3094
Practice Address - Country:US
Practice Address - Phone:255-518-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36138363LF0000X
OH0036138208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily