Individual provider Active NPI

Alyssa Johnson, APRN

  • Family Nurse Practitioner
  • Omaha, NE
National Provider Identifier
1326504978
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
112963 Issued in NE
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

Updated by the provider on Jul 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190607000642 IA Order and Referring Only - Nurse Practitioner 4385977248

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7637MNMDSpeech-Language Pathologist
257536AZMDFamily Nurse Practitioner
C-APN.0002118-C-NPCOMDFamily Nurse Practitioner
GAA-NP000125GAMDFamily Nurse Practitioner
209022619ILMDFamily Nurse Practitioner
71010220CINMDFamily Nurse Practitioner
53-79541-081KSMDFamily Nurse Practitioner
3014699KYMDFamily Nurse Practitioner
CNP201218MEMDFamily Nurse Practitioner
4704366158MIMDFamily Nurse Practitioner
2020019582MOMDFamily Nurse Practitioner
R49241NDMDFamily Nurse Practitioner
112963NEMDFamily Nurse Practitioner
AP138620TXMDFamily 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

Verify at the official NPI Registry.