Basic Information
| Provider Information | |||||||||
| NPI: | 1942878020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | LEXA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 MARKETPLACE PLZ STE 200 | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804871841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708796663 | ||||||||
| FaxNumber: | 9708711234 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 COUNTY ROAD 804 | ||||||||
| Address2: | |||||||||
| City: | FRASER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804425001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703642070 | ||||||||
| FaxNumber: | 9708796663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2021 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN.0996451-NP | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | APN.0996451-NP | 01 | CO | STATE OF COLORADO | OTHER | F02210037 | 01 | AMERICAN ACADEMY OF NURSE PRACTITIONERS | OTHER | E06210015 | 01 | AMERICAN ACADEMY OF NURSE PRACTITIONERS | OTHER |