KELLY KENNEDY-JOHNSON LPCC
NPI 1477256428
Counselor - Mental Health in Afton, MN
About Kelly Kennedy-johnson Lpcc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY KENNEDY-JOHNSON LPCC (NPI 1477256428) is an individual mental health provider in Afton, Minnesota, licensed in Minnesota (CC03678) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Kennedy-johnson Lpcc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Kennedy-johnson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Saint Paul, MN 55114
- Reassigned Medicare billing, Minnesota enrollment
- 17 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Kennedy-johnson's NPI number?
The NPI number for Kelly Kennedy-johnson is 1477256428. It was assigned to this individual provider in the NPPES registry on March 27, 2023.
Where is Kelly Kennedy-johnson located?
Kelly Kennedy-johnson practices at 15489 45th St S, Afton, MN 55001. The listed phone number is (612) 367-6046.
What is Kelly Kennedy-johnson's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Kelly Kennedy-johnson enrolled in Medicare?
Yes. Kelly Kennedy-johnson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Kennedy-johnson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Kennedy-johnson reassigns Medicare benefits to Susan Borden Psych (Saint Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Kennedy-johnson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Kennedy-johnson was last updated on March 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Kennedy-Johnson, LPCC · NPI 1477256428
Mental Health provider in Afton, Minnesota. Individual provider, active in the CMS NPPES registry since March 27, 2023.
## Identity
- **NPI:** 1477256428 (Entity type: Individual)
- **Enumerated:** March 27, 2023
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** CC03678 (Minnesota)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 15489 45TH ST S, Afton, MN 55001-9681
- **Phone:** (612) 367-6046
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Susan Borden Psych (NPI 1780313478, Saint Paul, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** March 27, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1477256428) · Data from the CMS NPPES public registry.