Active NPI
Alyssa Johnson, APRN
- Family Nurse Practitioner
- Omaha, NE
National Provider Identifier
1326504978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 112963
- Practice address
- 17645 Wright St Ste 300
Omaha, NE 68130-2195 - Phone
- (833) 667-2967
- NPI assigned
- Feb 19, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 257536 | AZ | |
| Family Nurse Practitioner | 363LF0000X | GAA-NP000125 | GA | |
| Family Nurse Practitioner | 363LF0000X | 209022619 | IL | |
| Family Nurse Practitioner | 363LF0000X | 7637 | MN | |
| Family Nurse Practitioner | 363LF0000X | 4704366158 | MI | |
| Family Nurse Practitioner | 363LF0000X | CNP201218 | ME | |
| Family Nurse Practitioner | 363LF0000X | 3014699 | KY | |
| Family Nurse Practitioner | 363LF0000X | 53-79541-081 | KS | |
| Family Nurse Practitioner | 363LF0000X | A132839 | IA | |
| Family Nurse Practitioner | 363LF0000X | 71010220C | IN | |
| Family Nurse Practitioner | 363LF0000X | C-APN.0002118-C-NP | CO | |
| Family Nurse Practitioner | 363LF0000X | AP138620 | TX | |
| Family Nurse Practitioner | 363LF0000X | R49241 | ND | |
| Family Nurse Practitioner | 363LF0000X | 2020019582 | MO | |
| Family Nurse Practitioner | 363LF0000X | 112963 | NE | Primary |
Addresses
Primary practice location
17645 Wright St Ste 300
Omaha, NE 68130-2195
Mailing address
17645 Wright St Ste 300
Omaha, NE 68130-2195
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Omaha |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190607000642 | IA | Order and Referring Only - Nurse Practitioner | 4385977248 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7637 | MN | MD | Speech-Language Pathologist |
| 257536 | AZ | MD | Family Nurse Practitioner |
| C-APN.0002118-C-NP | CO | MD | Family Nurse Practitioner |
| GAA-NP000125 | GA | MD | Family Nurse Practitioner |
| 209022619 | IL | MD | Family Nurse Practitioner |
| 71010220C | IN | MD | Family Nurse Practitioner |
| 53-79541-081 | KS | MD | Family Nurse Practitioner |
| 3014699 | KY | MD | Family Nurse Practitioner |
| CNP201218 | ME | MD | Family Nurse Practitioner |
| 4704366158 | MI | MD | Family Nurse Practitioner |
| 2020019582 | MO | MD | Family Nurse Practitioner |
| R49241 | ND | MD | Family Nurse Practitioner |
| 112963 | NE | MD | Family Nurse Practitioner |
| AP138620 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626825600000",
"number": "1326504978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17645 WRIGHT ST STE 300",
"city": "OMAHA",
"state": "NE",
"postal_code": "681302195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17645 WRIGHT ST STE 300",
"city": "OMAHA",
"state": "NE",
"postal_code": "681302195",
"telephone_number": "833-667-2967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ALYSSA",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-19",
"last_updated": "2021-07-21",
"certification_date": "2021-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "257536",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "GAA-NP000125",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209022619",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "7637",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704366158",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ME",
"license": "CNP201218",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "KY",
"license": "3014699",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "KS",
"license": "53-79541-081",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IA",
"license": "A132839",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "71010220C",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CO",
"license": "C-APN.0002118-C-NP",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP138620",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ND",
"license": "R49241",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2020019582",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NE",
"license": "112963",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Omaha",
"affiliation": "N",
"address_1": "17645 Wright St Ste 300",
"city": "Omaha",
"state": "NE",
"country_code": "US",
"postal_code": "681302195",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.