Active NPI
Abby Johnson, LAT
- Athletic Trainer
- Eden Prairie, MN
National Provider Identifier
1225447113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2741
- Practice address
- 16550 W 78TH Street
Suite B
Eden Prairie, MN 55346 - Phone
- (952) 873-7400
- NPI assigned
- Aug 5, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1509-39 | WI | |
| Athletic Trainer | 2255A2300X | 2741 | MN | Primary |
Addresses
Primary practice location
16550 W 78TH Street
Suite B
Eden Prairie, MN 55346
Mailing address
16650 West 78TH Street
Suite B
Eden Prairie, MN 55346
Phone (952) 873-7400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1509-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464134400000",
"number": "1225447113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16650 WEST 78TH STREET",
"address_2": "SUITE B",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "55346",
"telephone_number": "952-873-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16550 W 78TH STREET",
"address_2": "SUITE B",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "55346",
"telephone_number": "952-873-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ABBY",
"credential": "LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-05",
"last_updated": "2016-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1509-39",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.