Active NPI
Kendal Repass, ATC
- Athletic Trainer
- Poteau, OK
National Provider Identifier
1154708477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT480
- Practice address
- 17100 Nail Creek
Poteau, OK 74953 - Phone
- (918) 721-3923
- NPI assigned
- May 6, 2015
- Sex
- Male
- 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 | AT480 | OK | Primary |
Addresses
Primary practice location
17100 Nail Creek
Poteau, OK 74953
Mailing address
PO Box 492
Poteau, OK 74953-0492
Phone (918) 721-3923
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 |
|---|---|---|---|
| AT480 | OK | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430870400000",
"number": "1154708477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 492",
"city": "POTEAU",
"state": "OK",
"postal_code": "749530492",
"telephone_number": "918-721-3923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17100 NAIL CREEK",
"city": "POTEAU",
"state": "OK",
"postal_code": "74953",
"telephone_number": "918-721-3923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REPASS",
"first_name": "KENDAL",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-06",
"last_updated": "2015-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OK",
"license": "AT480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poteau, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.