Mary Pesicka, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2018026629 Issued in MO

Practice address

1000 W Austin Blvd
Nevada, MO 64772-2763

Phone

(417) 667-8181

NPI assigned

Aug 28, 2018

Last updated

Mar 1, 2021By the provider in NPPES

Sex

Female

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": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1043791072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W AUSTIN BLVD",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647722763",
            "telephone_number": "216-509-6218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W AUSTIN BLVD",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647722763",
            "telephone_number": "417-667-8181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N Benton Ave",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658023712",
            "country_code": "US",
            "telephone_number": "216-509-6218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PESICKA",
        "first_name": "MARY",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-28",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2018026629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Byron Leonard Perkinson, M.D.
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• Kelsey Pettit, PLPC
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• Nancy Pitts
• Susanne Platt, L.C.S.W.

• Athletic Trainer in Nevada, MO
• Providers in Nevada, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; 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.