Kelly Marie Johnson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.017943 Issued in IL

Practice address

40 Skokie Blvd
Northbrook, IL 60062-1601

Phone

(847) 291-3999

NPI assigned

Aug 31, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 17, 2024 through Apr 17, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kelly.johnson.1@21117.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midwest Center for Women'S Health Care, LTD.

  • Obstetrics & Gynecology Physician
  • Bannockburn, IL
  • NPI 1447200654

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1083196554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 SKOKIE BLVD STE 550",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621617",
            "telephone_number": "312-440-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SKOKIE BLVD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621601",
            "telephone_number": "847-291-3999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "737 N Michigan Ave Ste 600",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606116662",
            "country_code": "US",
            "telephone_number": "312-440-3810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-31",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.017943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Hardie PHD Clinical Psychologist LLC
• Rebecca John
• Erica Johnson, BCBA
• Flynn Mary Johnson, M.S., LMFT
• Jaclyn Stillmaker Johnson, MOT, OTR/L
• Lindsey Johnson, LPC
• Lindy Johnson, PT, DPT
• Rachel Johnson
• Taylor Johnson, OTR/L
• Tyler Johnston, RBT-19-85988

• Family Nurse Practitioner in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.