MEDICARE: KARI JOHNSTON ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2604	MN

General Provider Information

NPI Number	:	1952804130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI JOHNSTON ATC

Provider Business Mailing Address
First Line	:	5836 BLAINE AVE STE 105
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 BLAINE AVE STE 105
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1400
Country	:	US
Telephone Number	:	651-455-0535
Fax Number	:	651-455-1565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	03/14/2018

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