Active NPI
Denise Renee Grider, MS, ATC, CSCS, PES
- Athletic Trainer
- Kirkwood, MO
National Provider Identifier
1114203213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2007031478
- Practice address
- 801 W Essex Ave
Kirkwood, MO 63122-3608 - Phone
- (314) 213-6100
- NPI assigned
- Nov 2, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | 2007031478 | MO | Primary |
Addresses
Primary practice location
801 W Essex Ave
Kirkwood, MO 63122-3608
Mailing address
614 Briar Lake PL
Columbia, IL 62236-2751
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007031478 | MO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1114203213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 BRIAR LAKE PL",
"city": "COLUMBIA",
"state": "IL",
"postal_code": "622362751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 W ESSEX AVE",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631223608",
"telephone_number": "314-213-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIDER",
"first_name": "DENISE",
"middle_name": "RENEE",
"credential": "MS, ATC, CSCS, PES",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-02",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2007031478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.