Kendra Johnson, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

39542 Golden Lake Park Rd
Oconomowoc, WI 53066-9405

Phone

(262) 719-9072

NPI assigned

May 1, 2019

Last updated

Nov 27, 2023By the provider in NPPES

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: kendra.johnson4@ascension.org

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1407411861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39542 GOLDEN LAKE PARK RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530669405",
            "telephone_number": "262-719-9072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39542 GOLDEN LAKE PARK RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530669405",
            "telephone_number": "262-719-9072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 15th Ave",
            "address_purpose": "LOCATION",
            "city": "South Milwaukee",
            "state": "WI",
            "postal_code": "531721502",
            "country_code": "US",
            "telephone_number": "414-325-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENDRA",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-01",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Oconomowoc",
            "affiliation": "N",
            "address_1": "39542 Golden Lake Park Rd",
            "city": "Oconomowoc",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530669405",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kendra.johnson4@ascension.org",
            "affiliation": "Y",
            "endpointDescription": "Work Email Address",
            "affiliationName": "Ascension Sports Medicine, Inc",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Work",
            "address_1": "10101 S 27th St",
            "city": "Franklin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531327209",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.