Active NPI
Keegan Shea Cossio, LAT, ATC
- Athletic Trainer
- Missoula, MT
National Provider Identifier
1235649138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATR-LAT-LIC-1881
- Practice address
- 3220 N Reserve St
Missoula, MT 59808-1556 - Phone
- (406) 396-7532
- NPI assigned
- Oct 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Athletic Trainer | 2255A2300X | ATR-LAT-LIC-1881 | MT | Primary |
Addresses
Primary practice location
3220 N Reserve St
Missoula, MT 59808-1556
Mailing address
9000 E Nichols Ave Ste 104
Centennial, CO 80112-3429
Phone (406) 396-7532
Other practice location 1
1101 Westwood St Apt 119
Bismarck, ND 58504-6290
Phone (406) 396-7532
Other names 1
- Keegan Shea Wickman
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-1881 | MT | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Briotix LP. | Past | 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.
-
- Prevention Professional
- Centennial, CO
- NPI 1447798517
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591056000000",
"number": "1235649138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9000 E NICHOLS AVE STE 104",
"city": "CENTENNIAL",
"state": "CO",
"postal_code": "801123429",
"telephone_number": "406-396-7532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 N RESERVE ST",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598081556",
"telephone_number": "406-396-7532"
}
],
"practiceLocations": [
{
"address_1": "1101 Westwood St Apt 119",
"address_purpose": "LOCATION",
"city": "Bismarck",
"state": "ND",
"postal_code": "585046290",
"country_code": "US",
"telephone_number": "406-396-7532",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "COSSIO",
"first_name": "KEEGAN",
"middle_name": "SHEA",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-05",
"last_updated": "2020-06-02",
"certification_date": "2020-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MT",
"license": "ATR-LAT-LIC-1881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KEEGAN",
"last_name": "WICKMAN",
"middle_name": "SHEA",
"credential": "LAT, ATC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.