Kellie Anita Johnson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21194 Issued in TX

Practice address

815 E Berry St # B
Ft Worth, TX 76110-4414

Phone

(817) 920-5919

NPI assigned

Oct 10, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Brident Dental Associates PC

  • Dentist
  • Fort Worth, TX
  • NPI 1376016469
  NPD (past)
• South Texas Dental Associates, L.P.

  • General Practice Dentistry
  • Ft Worth, TX
  • NPI 1447478847
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346337375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 WEST LOOP S STE 650",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "774012997",
            "telephone_number": "713-663-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E BERRY ST # B",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761104414",
            "telephone_number": "817-920-5919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLIE",
        "middle_name": "ANITA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Johnson, O.D.
• John W Johnson III, MD
• Jon Robert Johnson, CPO, LPO
• Kacie Johnson, NP-C
• Kayla Johnson, MA, BCBA
• Kelsie Aubrianne Johnson, SLP
• Kristal L Johnson
• Kyla Johnson, RBT
• Lovina Tramel Johnson, PT
• Madeline Grace Johnson

• General Practice Dentistry in Ft Worth, TX
• Providers in Ft Worth, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.