Active NPI
Lance Wayne Wilke, ATC, LAT, CSCS, PES
- Athletic Trainer
- Ingram, TX
National Provider Identifier
1225235666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT1583
- Practice address
- 101 Hillside Dr
Ingram, TX 78025-3126 - Phone
- (830) 367-2803
- NPI assigned
- Jun 29, 2007
- 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 | AT1583 | TX | Primary |
Addresses
Primary practice location
101 Hillside Dr
Ingram, TX 78025-3126
Mailing address
101 Hillside Dr
Ingram, TX 78025-3126
Phone (830) 367-2803
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 |
|---|---|---|---|
| AT1583 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225235666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 HILLSIDE DR",
"city": "INGRAM",
"state": "TX",
"postal_code": "780253126",
"telephone_number": "830-367-2803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 HILLSIDE DR",
"city": "INGRAM",
"state": "TX",
"postal_code": "780253126",
"telephone_number": "830-367-2803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKE",
"first_name": "LANCE",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "ATC, LAT, CSCS, PES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT1583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ingram, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.