Active NPI
Timothy Michael Kelly, ATC
- Athletic Trainer
- San Antonio, TX
National Provider Identifier
1255081071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT4991
- Practice address
- 1170 Eagle Dr BLDG 150
San Antonio, TX 78236-5705 - Phone
- (210) 671-9177
- NPI assigned
- Mar 25, 2022
- 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 | AT4991 | TX | Primary |
Addresses
Primary practice location
1170 Eagle Dr BLDG 150
San Antonio, TX 78236-5705
Mailing address
1170 Eagle Dr BLDG 150
San Antonio, TX 78236-5705
Phone (210) 671-9177
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 |
|---|---|---|---|
| AT4991 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1255081071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1170 EAGLE DR BLDG 150",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782365705",
"telephone_number": "210-671-9177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1170 EAGLE DR BLDG 150",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782365705",
"telephone_number": "210-671-9177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TIMOTHY",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-25",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT4991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.