Provider Demographics
NPI:1538944293
Name:JOHNSON, ALEXIS M (NP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:M
Other - Last Name:LOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13500 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1322
Practice Address - Country:US
Practice Address - Phone:260-726-2313
Practice Address - Fax:317-222-2071
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28244078C163W00000X
IN71014337A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1103736653OtherANTHEM PTAN
IN300082442Medicaid
IN300082442Medicaid