Active NPI
Kelley Lucille Weidinger, ATC, LAT
- Athletic Trainer
- Jefferson City, MO
National Provider Identifier
1093910812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2007017252
- Practice address
- 3308 W Edgewood Dr Ste F
Jefferson City, MO 65109-6891 - Phone
- (573) 638-3400
- Fax
- (573) 638-3405
- NPI assigned
- Jun 20, 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 | 2007017252 | MO | Primary |
Addresses
Primary practice location
3308 W Edgewood Dr Ste F
Jefferson City, MO 65109-6891
Mailing address
11820 Maries Road 328
Vienna, MO 65582-7123
Phone (573) 680-3826
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 |
|---|---|---|---|
| 2007017252 | MO | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Curators of the University of Missouri | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mizzou Pharmacy - Southwest Blvd
- Community/Retail Pharmacy
- Jefferson City, MO
- NPI 1740083641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093910812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11820 MARIES ROAD 328",
"city": "VIENNA",
"state": "MO",
"postal_code": "655827123",
"telephone_number": "573-680-3826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3308 W EDGEWOOD DR STE F",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651096891",
"telephone_number": "573-638-3400",
"fax_number": "573-638-3405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIDINGER",
"first_name": "KELLEY",
"middle_name": "LUCILLE",
"name_prefix": "Miss",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2007017252",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
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.