Provider Demographics
NPI:1639068141
Name:PELTON JOHNSON, AUDRI ALEXANDRA
Entity type:Individual
Prefix:
First Name:AUDRI
Middle Name:ALEXANDRA
Last Name:PELTON JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDRI
Other - Middle Name:ALEXANDRA
Other - Last Name:PELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3530
Mailing Address - Country:US
Mailing Address - Phone:308-535-7132
Mailing Address - Fax:
Practice Address - Street 1:2000 W 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3530
Practice Address - Country:US
Practice Address - Phone:308-535-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool