Jessica Renee Johnson, AT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601000661 Issued in MI

Practice address

2160 Coolidge Hwy
Berkley, MI 48072-1547

Phone

(248) 691-4700

NPI assigned

Nov 8, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1972016319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 COOLIDGE HWY",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480721547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 COOLIDGE HWY",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480721547",
            "telephone_number": "248-691-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2325 Catalpa Dr",
            "address_purpose": "LOCATION",
            "city": "Berkley",
            "state": "MI",
            "postal_code": "480721851",
            "country_code": "US",
            "telephone_number": "248-837-8129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSICA",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "AT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Jackson, PA-C
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• Jodie Heicklen LMSW, PLLC
• Sparkle Crujhon Johnson, LLMSW
• Matthew Jones, M.D.
• Tristen John Jorah, LLMSW
• Diora Christina Jouja, D.D.S.
• Laurin Becca Jozlin, LMSW

• Athletic Trainer in Berkley, MI
• Providers in Berkley, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.