Individual provider Active NPI

Kasey Bethancourt Johnson, MS, CCC-SLP

  • Speech-Language Pathologist
  • Cary, NC
National Provider Identifier
1699291351
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
111 Mackenan Dr
Cary, NC 27511-7903
Phone
(919) 371-2848
NPI assigned
Aug 15, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

111 Mackenan Dr
Cary, NC 27511-7903

Mailing address

200 Trent Dr
Durham, NC 27710-3037
Phone (919) 684-3859

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210205000269 NC Practitioner - Qualified Speech Language Pathologist 9830503630 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
14076NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Sep 28, 2020 Accepting new patients
Duke University Health System, Inc. CurrentSince May 31, 2025 Accepting new patients
Duke University Health System, Inc. CurrentSince Sep 28, 2020 Accepting new patients
Carolina Center for Autism Services, LLC Past Accepting new patients
The Carolina Center for ABA & Autism Treatment Past Accepting new patients

Locations

801 W Barbee Chapel Rd
#100
Chapel Hill, NC 27517
Phone (919) 385-2600

200 Trent Dr
Durham, NC 27710
Phone (919) 613-7797

3000 Erwin Rd
Durham, NC 27705
Phone (919) 668-3988

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

10211 Alm St
Ste 212
Raleigh, NC 27617
Phone (919) 206-4868

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1699291351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TRENT DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277103037",
            "telephone_number": "919-684-3859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MACKENAN DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275117903",
            "telephone_number": "919-371-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KASEY",
        "middle_name": "BETHANCOURT",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.