Kalli Ann Johnson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2525 Issued in MN

Practice address

2515 White Bear Ave N
Maplewood, MN 55109-5155

Phone

(507) 261-1716

NPI assigned

Nov 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kalli Ann Clark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1235672023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11154 DRAKE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554337434",
            "telephone_number": "507-261-1716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 WHITE BEAR AVE N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095155",
            "telephone_number": "507-261-1716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KALLI",
        "middle_name": "ANN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "2525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KALLI",
            "last_name": "CLARK",
            "middle_name": "ANN",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bradley S Johnson, MD
• Christine Johnson
• Jennifer Joray Johnson
• Jodi Lynn Johnson, NP
• Julie A Johnson, CRNA
• Karyn Johnson
• Paul R Johnson, MD
• Thomas Hagge Johnson, M.D.
• Rachael Johnston, PA-C
• Randall David Johson, DDS

• Athletic Trainer in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.

Verify at the official NPI Registry.