Clinton Charles Wynn

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL1337 Issued in FL

Practice address

5722 Biscayne CT # Condo108
New Port Richey, FL 34652-2031

Phone

(727) 534-4755

Fax

(727) 843-0401

NPI assigned

Jul 17, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468713600000",
    "number": "1124471958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5722 BISCAYNE CT # CONDO108",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346522031",
            "telephone_number": "727-534-4755",
            "fax_number": "727-843-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5722 BISCAYNE CT # CONDO108",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346522031",
            "telephone_number": "727-534-4755",
            "fax_number": "727-843-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "CLINTON",
        "middle_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-17",
        "last_updated": "2016-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL1337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn E Wright, LCSW
• Jennifer Wrublevski, LMT
• Ming Jiang Wu, M.D.
• Jesse Andrew Wunsch, PHARMD
• Shaina Wyatt
• Zackery T Wynn, D.C
• Hariom Yadav
• Stephanie Lynne Yanase, M.D.
• Jimin Yang
• Sailan Yao, BSA

• Athletic Trainer in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.