Active NPI
Harrison Randall Faulk, LAT, ATC, PES
- Athletic Trainer
- Great Falls, MT
National Provider Identifier
1215649256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATR-LAT-LIC-2685
- Practice address
- 228 17TH Ave NW
Great Falls, MT 59404-1807 - Phone
- (406) 268-6100
- NPI assigned
- Dec 21, 2022
- 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 | ATR-LAT-LIC-2685 | MT | Primary |
Addresses
Primary practice location
228 17TH Ave NW
Great Falls, MT 59404-1807
Mailing address
228 17TH Ave NW
Great Falls, MT 59404-1807
Phone (406) 268-6100
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 |
|---|---|---|---|
| ATR-LAT-LIC-2685 | MT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671580800000",
"number": "1215649256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 17TH AVE NW",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594041807",
"telephone_number": "406-268-6100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 17TH AVE NW",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594041807",
"telephone_number": "406-268-6100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULK",
"first_name": "HARRISON",
"middle_name": "RANDALL",
"credential": "LAT, ATC, PES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-21",
"last_updated": "2022-12-21",
"certification_date": "2022-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MT",
"license": "ATR-LAT-LIC-2685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.