Active NPI
Kenneth Todd Johnson
- Athletic Trainer
- Seminole, FL
National Provider Identifier
1821562091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- J525518662420
- Practice address
- 11470 88TH Ave
Seminole, FL 33772-3602 - Phone
- (727) 623-0676
- NPI assigned
- Jan 21, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | J525518662420 | FL | Primary |
Addresses
Primary practice location
11470 88TH Ave
Seminole, FL 33772-3602
Mailing address
11470 88TH Ave
Seminole, FL 33772-3602
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 |
|---|---|---|---|
| J525518662420 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548028800000",
"number": "1821562091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11470 88TH AVE",
"city": "SEMINOLE",
"state": "FL",
"postal_code": "337723602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11470 88TH AVE",
"city": "SEMINOLE",
"state": "FL",
"postal_code": "337723602",
"telephone_number": "727-623-0676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KENNETH",
"middle_name": "TODD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-21",
"last_updated": "2019-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "J525518662420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seminole, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.