Kelly Johnson, MSAT, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126003041 Issued in VA

Practice address

255 Thole St
Norfolk, VA 23505-4199

Phone

(757) 423-5770

NPI assigned

Nov 29, 2016

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": "1480377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1396288965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9553 25TH BAY ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235181811",
            "telephone_number": "267-241-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 THOLE ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054199",
            "telephone_number": "757-423-5770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "404 Sweetbriar Ct",
            "address_purpose": "LOCATION",
            "city": "Yardley",
            "state": "PA",
            "postal_code": "190674760",
            "country_code": "US",
            "telephone_number": "267-241-7385",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9553 25th Bay St",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235181811",
            "country_code": "US",
            "telephone_number": "267-241-7385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "credential": "MSAT, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-29",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126003041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gracie Beth Johnson, APRN
• Janell Johnson
• Jeanelle Johnson, PA-C
• Julie Bailey Johnson, PA-C
• Justin Johnson, PA
• Kendallyn Johnson
• Kristina Ryan Johnson
• Lakisha Johnson, LPC
• Laurie Johnson, PT
• Lucas Andrew Johnson, M.D.

• Athletic Trainer in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.