Active NPI
Kevin Hansen
- Athletic Trainer
- Jackson, TN
National Provider Identifier
1194340430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1479
- Practice address
- 1378 Union University Dr
Jackson, TN 38305-3780 - Phone
- (731) 664-7060
- Fax
- (731) 664-5005
- NPI assigned
- Jun 12, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 1479 | TN | Primary |
Addresses
Primary practice location
1378 Union University Dr
Jackson, TN 38305-3780
Mailing address
1804 Highway 45 Byp Ste 604
Jackson, TN 38305-4403
Phone (731) 660-8781
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 |
|---|---|---|---|
| 1479 | TN | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wild Clarity Counseling | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- Lexington, TN
- NPI 1588246680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591920000000",
"number": "1194340430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 HIGHWAY 45 BYP STE 604",
"city": "JACKSON",
"state": "TN",
"postal_code": "383054403",
"telephone_number": "731-660-8781",
"fax_number": "731-660-8739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1378 UNION UNIVERSITY DR",
"city": "JACKSON",
"state": "TN",
"postal_code": "383053780",
"telephone_number": "731-664-7060",
"fax_number": "731-664-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-12",
"last_updated": "2020-06-12",
"certification_date": "2020-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "1479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.