Stacey John, ATC, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2280 Issued in MN

Practice address

3580 Arcade St
Vadnais Heights, MN 55127-7135

Phone

(651) 968-5375

Fax

(651) 968-5907

NPI assigned

Jun 12, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1144634601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1285 NININGER RD",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550331086",
            "telephone_number": "651-968-5413",
            "fax_number": "651-437-2988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 ARCADE ST",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551277135",
            "telephone_number": "651-968-5375",
            "fax_number": "651-968-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "STACEY",
        "credential": "ATC, OTC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "MN",
            "license": "18-2775",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "2280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Cochrane Huntoon
• Infinite Health Collaborative, PA
• Joshua F Januschka, MA, LPCC
• Hannah Grace Jensen
• Lisa Marie Johanson
• Alecia Ann Johnson, PT
• Alyssa N Johnson, DPT
• Greg Michael Johnson, M.D
• Kelsey Nicole Johnson, PMHNP-BC
• Joanne Kaseman, PA-C

• Athletic Trainer in Vadnais Heights, MN
• Providers in Vadnais Heights, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.