Active NPI
Angela Christine Bushmaker, LAT, ATC
- Athletic Trainer
- Buckley, WA
National Provider Identifier
1124356217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A1 60035165
- Practice address
- 14107 State Route 165 E
Buckley, WA 98321-9387 - Phone
- (360) 829-2525
- Fax
- (360) 829-2525
- NPI assigned
- Nov 30, 2009
- 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 | A1 60035165 | WA | Primary |
Addresses
Primary practice location
14107 State Route 165 E
Buckley, WA 98321-9387
Mailing address
14107 State Route 165 E
Buckley, WA 98321-9387
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 |
|---|---|---|---|
| A1 60035165 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1259539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589155200000",
"number": "1124356217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14107 STATE ROUTE 165 E",
"city": "BUCKLEY",
"state": "WA",
"postal_code": "983219387",
"fax_number": "360-829-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14107 STATE ROUTE 165 E",
"city": "BUCKLEY",
"state": "WA",
"postal_code": "983219387",
"telephone_number": "360-829-2525",
"fax_number": "360-829-2525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSHMAKER",
"first_name": "ANGELA",
"middle_name": "CHRISTINE",
"name_prefix": "Dr.",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-30",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A1 60035165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckley, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.