Brice Anderson, MSAT, LAT, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT-657 Issued in ID

Practice address

777 Hospital Way
Pocatello, ID 83201-5175

Phone

(208) 242-8650

NPI assigned

Apr 5, 2018

Sex

Male

Sole proprietor

No

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": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1043716285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 SARATOGA ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012253",
            "telephone_number": "208-242-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-242-8650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1412 Saratoga St",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "83201",
            "country_code": "US",
            "telephone_number": "208-242-8650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "BRICE",
        "credential": "MSAT, LAT, ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-05",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista Jean Andersen-Harris, DO
• Douglas Ken Andersen, DO
• Joseph Soren Andersen
• Matthew Colt Andersen, LPC
• Angela Babb Anderson, PT
• Bryan Wayne Anderson, NCC
• Danielle Lynn Anderson, RN
• Garret Anderson
• Gary Steven Anderson
• Isabella Raquel Anderson, LPC

• All providers in Pocatello, ID
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.

Verify at the official NPI Registry.