Active NPI
Kendallyn Johnson
- Sports Medicine (Internal Medicine) Physician
- Norfolk, VA
National Provider Identifier
1790424760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Internal Medicine) Physician
- License
- 390200000X
- Practice address
- 5115 Hampton Blvd
Norfolk, VA 23529-5000 - Phone
- (757) 683-3000
- NPI assigned
- May 29, 2022
- 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 |
|---|---|---|---|---|
| Sports Medicine (Internal Medicine) Physician | 207RS0010X | 390200000X | VA | Primary |
Addresses
Primary practice location
5115 Hampton Blvd
Norfolk, VA 23529-5000
Mailing address
103 Clearfield Cir Apt a
Colonial Heights, VA 23834-1858
Phone (804) 930-3507
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 |
|---|---|---|---|
| 390200000X | VA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653782400000",
"number": "1790424760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 CLEARFIELD CIR APT A",
"city": "COLONIAL HEIGHTS",
"state": "VA",
"postal_code": "238341858",
"telephone_number": "804-930-3507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5115 HAMPTON BLVD",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235295000",
"telephone_number": "757-683-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KENDALLYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-29",
"last_updated": "2022-05-29",
"certification_date": "2022-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RS0010X",
"taxonomy_group": "",
"desc": "Internal Medicine, Sports Medicine",
"state": "VA",
"license": "390200000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.