Kimberly Renee Johnson, EP

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

License

901698244 Issued in VA

Practice address

5645 Danvers Rd
Portsmouth, VA 23703-3730

Phone

(804) 368-9767

NPI assigned

Jul 30, 2020

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

Other identifiers 1

Electronic endpoints 1

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": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1255940698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 DANVERS RD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033730",
            "telephone_number": "804-368-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 DANVERS RD",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033730",
            "telephone_number": "804-368-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "EP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Y00000X",
            "taxonomy_group": "",
            "desc": "Clinical Exercise Physiologist",
            "state": "VA",
            "license": "901698244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACSM - AMERICAN COLLEGE OF SPORTS MEDICINE",
            "identifier": "901698244",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Portsmouth",
            "affiliation": "N",
            "endpointDescription": "phone",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Portsmouth",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Portsmouth",
            "address_1": "5645 Danvers Rd",
            "city": "Portsmouth",
            "state": "VA",
            "country_code": "US",
            "postal_code": "237033730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Clark Johnson, MS, PT
• Hailey Anne Johnson, MD
• Joshua Heath Johnson, M.D.
• Judy Delois Johnson
• Kimberly Johnson, R.N.
• Kristi Johnson, M.S., CCC-SLP
• Kyle Robert Johnson, DDS
• Lisa Maria Johnson, PHARMD
• Mark Stephen Johnson, MD
• Rebecca Lynn Johnson, M.D.

• Clinical Exercise Physiologist in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Clinical Exercise Physiologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.