Active NPI
Kimberly Ann Johnson, CCC/SLP
- Speech-Language Pathologist
- Eagle River, AK
National Provider Identifier
1407255680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 197
- Practice address
- 9244 Biorka Cir
Eagle River, AK 99577-8619 - Phone
- (907) 240-9970
- NPI assigned
- Aug 14, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 197 | AK | Primary |
Addresses
Primary practice location
9244 Biorka Cir
Eagle River, AK 99577-8619
Mailing address
9244 Biorka Cir
Eagle River, AK 99577-8619
Phone (907) 240-9970
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01098951 | Other | ASHA NATIONAL CERTIFICATION | |
| SLPS 197 | Other | AK | PROFESSIONAL BUSINESS LICENSE |
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 |
|---|---|---|---|
| 197 | AK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1407255680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9244 BIORKA CIR",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995778619",
"telephone_number": "907-240-9970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9244 BIORKA CIR",
"city": "EAGLE RIVER",
"state": "AK",
"postal_code": "995778619",
"telephone_number": "907-240-9970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"credential": "CCC/SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-14",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AK",
"license": "197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA NATIONAL CERTIFICATION",
"identifier": "01098951",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL BUSINESS LICENSE",
"identifier": "SLPS 197",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.