Active NPI
Carly J Wilson, MS, LAT, ATC
- Athletic Trainer
- Boise, ID
National Provider Identifier
1205326642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 1109 W Myrtle St Ste 200
Boise, ID 83702-6975 - Phone
- (208) 489-4300
- NPI assigned
- May 10, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
1109 W Myrtle St Ste 200
Boise, ID 83702-6975
Mailing address
1051 Southern Dr Unit 2108
Columbia, SC 29201-5608
Other practice location 1
Blatt Pe Center - Exercise Science 1300 Wheat Street
Columbia, SC 29208-1121
Phone (803) 777-0636
Other practice location 2
2000 Observatory Dr
Madison, WI 53706-1121
Phone (608) 262-3742
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1205326642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1051 SOUTHERN DR UNIT 2108",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292015608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1109 W MYRTLE ST STE 200",
"city": "BOISE",
"state": "ID",
"postal_code": "837026975",
"telephone_number": "208-489-4300"
}
],
"practiceLocations": [
{
"address_1": "Blatt Pe Center - Exercise Science 1300 Wheat Street",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "SC",
"postal_code": "292081121",
"country_code": "US",
"telephone_number": "803-777-0636",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2000 Observatory Dr",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537061121",
"country_code": "US",
"telephone_number": "608-262-3742",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "CARLY",
"middle_name": "J",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-10",
"last_updated": "2021-09-09",
"certification_date": "2021-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.