Active NPI
Kristen Marie Dodge
- Athletic Trainer
- Clinton, SC
National Provider Identifier
1063921146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2178
- Practice address
- 105 Ashland Ave
Clinton, SC 29325-2960 - Phone
- (864) 347-5707
- NPI assigned
- Sep 21, 2017
- 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 | 2178 | SC | Primary |
Addresses
Primary practice location
105 Ashland Ave
Clinton, SC 29325-2960
Mailing address
601 Cedar Street
Apt 6a
Clinton, SC 29325
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505952000000",
"number": "1063921146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 CEDAR STREET",
"address_2": "APT 6A",
"city": "CLINTON",
"state": "SC",
"postal_code": "29325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 ASHLAND AVE",
"city": "CLINTON",
"state": "SC",
"postal_code": "293252960",
"telephone_number": "864-347-5707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "KRISTEN",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-21",
"last_updated": "2017-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "SC",
"license": "2178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.