Kelley L Johnson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN253424 Issued in GA

Practice address

1515 River PL Ste 100
Braselton, GA 30517-5610

Phone

(770) 848-6195

NPI assigned

Jun 21, 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

Other names 1

• Kelley L Russell Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL, GA2 enrollments

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjohnson30126@nghs.gadirect.net

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.

• Afc Physicians of Georgia Primary Care, PC

  • Primary Care Clinic/Center
  • Fort Oglethorpe, GA
  • NPI 1780062380
  Medicare reassignment NPD
• American Family Care, LLC

  • Primary Care Clinic/Center
  • Birmingham, AL
  • NPI 1669429080
  Medicare reassignment NPD
• Afc Physicians of Georgia Primary Care, PC

  • Primary Care Clinic/Center
  • Fort Oglethorpe, GA
  • NPI 1083005565
  NPD
• American Family Care, LLC

  • Family Medicine Physician
  • Vestavia Hills, AL
  • NPI 1265210645
  NPD

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1538105267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 RIVER PL STE 100",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305175610",
            "telephone_number": "770-848-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLEY",
        "middle_name": "L",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN253424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnson30126@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1515 River Pl Ste 100",
            "city": "Braselton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305175610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "RUSSELL",
            "middle_name": "L",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Krystal N Ikemba-Madu, PHARMD
• Suzan Jackovatz, RDN, LD
• Yoomi Jang
• Holly Amber Johns, FNP-BC
• Connie Johnson
• Johnsons Hometown Pharmacy Inc (Johnson's River Place Pharmacy)
• Dewina Jones
• Angela M Joseph, PTA
• Fnu Kalpana
• Joseph Henry Kanclerz, MSN, NP-C, RNFA

• Family Nurse Practitioner in Braselton, GA
• Providers in Braselton, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.