Kristofer Vander Wilt, B.S., ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1936 Issued in TN

Practice address

1500 Greenland Dr
Murfreesboro, TN 37132-3100

Phone

(850) 499-1913

NPI assigned

Nov 23, 2015

Last updated

Nov 23, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kris Vander Wilt Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1174997506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 GREENLAND DR",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371323100",
            "telephone_number": "850-499-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 GREENLAND DR",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371323100",
            "telephone_number": "850-499-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WILT",
        "first_name": "KRISTOFER",
        "credential": "B.S., ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-23",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": "1936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESSEE STATE LICENSE NUMBER",
            "identifier": "1936",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRIS",
            "last_name": "VANDER WILT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Athletic Trainer in Murfreesboro, TN
• Providers in Murfreesboro, TN by specialty
• Athletic Trainer in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.

Verify at the official NPI Registry.