Kelly Marie Johnston, RD
Individual provider Active NPI Registered Dietitian · Micanopy, FL
NPI 1700748977 · NPPES record last updated Nov 26, 2025
Key facts
- NPI
- 1700748977
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- ND8921 (FL)
- Practice address
- 22484 NW 87TH Avenue Rd
Micanopy, FL 32667-7435 - Phone
- (970) 581-5173
- NPI assigned
- Nov 26, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND8921 | FL | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND8921 | FL | Yes |
Addresses
Primary practice location
22484 NW 87TH Avenue Rd
Micanopy, FL 32667-7435
Mailing address
22484 NW 87TH Avenue Rd
Micanopy, FL 32667-7435
Phone (970) 581-5173
Other providers in Micanopy, FL
- Valerie Broas
- Florida Good Health PLLC
- Sherry T. Gliesche
- Paula Goldberg
- Lisa Hager
- Eric Lanham
- Anna Belen Larson
- McIntosh Assisted Living
- Mallory Leblanc Pfaffly
- Caroline Roach
All providers in Micanopy, FL · Registered Dietitian in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.