Kelsey Diane Johnson, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

9595 Issued in KY

Practice address

1317 N Main St
Beaver Dam, KY 42320-8957

Phone

(270) 274-5121

Fax

(270) 274-5122

NPI assigned

Jul 17, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Bluegrass Family Dentistry, PLLC

  • Dentist
  • Beaver Dam, KY
  • NPI 1093241796
  NPD (past) Authorized official

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1891179966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 535",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423200535",
            "telephone_number": "270-274-5121",
            "fax_number": "270-274-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 N MAIN ST",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423208957",
            "telephone_number": "270-274-5121",
            "fax_number": "270-274-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELSEY",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-17",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9595",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "9595",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nicole Horn, O.T.D.
• Angela R Hudnall, APRN
• Kasey Hutto, OTR/L
• J.Dylan James, DPT
• Bridget Colette Johnson, ARNP
• Kentucky Medical Care
• Tariq K Malik, M.D.
• Susan B Matthews, ARNP
• Brian Mayes, PHARM.D, BCACP
• Samantha Mayes, PT

• Dentist in Beaver Dam, KY
• Providers in Beaver Dam, KY by specialty
• Dentist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.