Active NPI
Andrea Joellen Johnson I, PTA
- Physical Therapy Assistant
- Jenkins, KY
National Provider Identifier
1508072372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A01754
- Practice address
- 457 Bentley Loop
Jenkins, KY 41537-9004 - Phone
- (606) 832-1471
- Fax
- (606) 832-0397
- NPI assigned
- May 16, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A01754 | KY | Primary |
Addresses
Primary practice location
457 Bentley Loop
Jenkins, KY 41537-9004
Mailing address
582 WB Holw
Jenkins, KY 41537-9147
Phone (606) 633-3554
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 |
|---|---|---|---|
| A01754 | KY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508072372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "582 WB HOLW",
"city": "JENKINS",
"state": "KY",
"postal_code": "415379147",
"telephone_number": "606-633-3554",
"fax_number": "606-633-3627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "457 BENTLEY LOOP",
"city": "JENKINS",
"state": "KY",
"postal_code": "415379004",
"telephone_number": "606-832-1471",
"fax_number": "606-832-0397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ANDREA",
"middle_name": "JOELLEN",
"name_prefix": "Ms.",
"name_suffix": "I",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KY",
"license": "A01754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jenkins, KY
- Jenkins Healthcare Company Inc
- Jenkins Healthcare Company Inc
- Jenkins Healthcare Company Inc. Dba Jenkins Community Hospital
- Jenkins Independent School District
- Kassi Jessee, PHARMD
- Kentucky River District Health Department
- Kentucky River District Health Department
- Kentucky River District Health Department
- Benjamin Luke Kiser, ARNP
- Kolesnikov Pediatrics PLLC
Sources for this page
- 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.