Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Jeremy Ezra Johnson

Individual provider Athletic Trainer · NPI 1578197984

Mr. Jeremy Ezra Johnson is an Athletic Trainer in Stateline, Nevada. Practices as a sole proprietor. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

331 Tramway Dr # 16
Stateline, NV 89449-9812
Phone: (805) 610-3415
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X

Record details

NPI number1578197984
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 24, 2020
Last updated in NPPESFebruary 24, 2020
Certification dateFebruary 24, 2020

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