Active NPI
Kristina Johnson, RBT
- Behavior Technician
- Clover, SC
National Provider Identifier
1558069997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 22236257
- Practice address
- 2805 Kingsburry Rd
Clover, SC 29710-9167 - Phone
- (803) 504-9083
- NPI assigned
- Feb 15, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 22236257 | CO | |
| Behavior Technician | 106S00000X | 22236257 | NC | Primary |
Addresses
Primary practice location
2805 Kingsburry Rd
Clover, SC 29710-9167
Mailing address
2805 Kingsburry Rd
Clover, SC 29710-9167
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 |
|---|---|---|---|
| 22236257 | CO | MD | Behavioral Analyst |
| 22236257 | NC | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677628800000",
"number": "1558069997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 KINGSBURRY RD",
"city": "CLOVER",
"state": "SC",
"postal_code": "297109167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 KINGSBURRY RD",
"city": "CLOVER",
"state": "SC",
"postal_code": "297109167",
"telephone_number": "803-504-9083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KRISTINA",
"credential": "RBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-15",
"last_updated": "2023-03-01",
"certification_date": "2023-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CO",
"license": "22236257",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NC",
"license": "22236257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clover, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.