Active NPI
Kimberly R Detwiler, MS, LAT, ATC, CSCS
- Athletic Trainer
- Boulder, CO
National Provider Identifier
1265496194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT.0001754
- Practice address
- 2150 Stadium Drive
Boulder, CO 80309-7059 - Phone
- (512) 230-6171
- NPI assigned
- Apr 17, 2006
- Last updated
- Apr 9, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT.0001754 | CO | Primary |
Addresses
Primary practice location
2150 Stadium Drive
Boulder, CO 80309-7059
Mailing address
1166 Opal St Unit 102
Broomfield, CO 80020-7059
Phone (512) 230-6171
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT.0001754 | CO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1265496194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1166 OPAL ST UNIT 102",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800207059",
"telephone_number": "512-230-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2150 STADIUM DRIVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803097059",
"telephone_number": "512-230-6171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWILER",
"first_name": "KIMBERLY",
"middle_name": "R",
"credential": "MS, LAT, ATC, CSCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-17",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CO",
"license": "AT.0001754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.