Active NPI
Bridget Sullivan, ATC
- Athletic Trainer
- Winston-Salem, NC
National Provider Identifier
1003345554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-4697
- Practice address
- 4030 Wellman Way
Miller Center
Winston-Salem, NC 27109 - Phone
- (336) 758-4188
- NPI assigned
- Jun 8, 2017
- Reactivated
- Sep 26, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | LAT-4697 | NC | Primary |
Addresses
Primary practice location
4030 Wellman Way
Miller Center
Winston-Salem, NC 27109
Mailing address
126 Brookstown Ave Apt 150
Winston Salem, NC 27101-5377
Phone (615) 491-3014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-4697 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728604800000",
"number": "1003345554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 BROOKSTOWN AVE APT 150",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271015377",
"telephone_number": "615-491-3014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4030 WELLMAN WAY",
"address_2": "MILLER CENTER",
"city": "WINSTON-SALEM",
"state": "NC",
"postal_code": "27109",
"telephone_number": "336-758-4188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "BRIDGET",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-08",
"last_updated": "2024-10-11",
"certification_date": "2024-10-07",
"deactivation_date": "2017-12-05",
"reactivation_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-4697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston-Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.