Active NPI
Mindy S Depue, ATC
- Athletic Trainer
- Corvallis, OR
National Provider Identifier
1083744593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-AT-1007419
- Practice address
- 4444 NW Highland Dr
Corvallis, OR 97330-9734 - Phone
- (541) 766-4909
- NPI assigned
- Mar 6, 2007
- 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 | AT-AT-1007419 | OR | Primary |
Addresses
Primary practice location
4444 NW Highland Dr
Corvallis, OR 97330-9734
Mailing address
2491 Waterford St SE
Albany, OR 97322-8818
Phone (541) 990-2388
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 |
|---|---|---|---|
| AT-AT-1007419 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083744593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2491 WATERFORD ST SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973228818",
"telephone_number": "541-990-2388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 NW HIGHLAND DR",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973309734",
"telephone_number": "541-766-4909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPUE",
"first_name": "MINDY",
"middle_name": "S",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "AT-AT-1007419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.