Active NPI
Konnor Gerald Kingsmore, LAT, ATC
- Athletic Trainer
- Menomonee Falls, WI
National Provider Identifier
1295551240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 3219-39
- Practice address
- N91W15750 Falls Pkwy
Menomonee Falls, WI 53051-2301 - Phone
- (262) 532-1100
- NPI assigned
- Nov 25, 2024
- 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 | 3219-39 | WI | Primary |
Addresses
Primary practice location
N91W15750 Falls Pkwy
Menomonee Falls, WI 53051-2301
Mailing address
W64N14273 Washington Ave Apt 129
Cedarburg, WI 53012-3035
Phone (719) 510-5126
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 |
|---|---|---|---|
| 3219-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732492800000",
"number": "1295551240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W64N14273 WASHINGTON AVE APT 129",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530123035",
"telephone_number": "719-510-5126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N91W15750 FALLS PKWY",
"city": "MENOMONEE FALLS",
"state": "WI",
"postal_code": "530512301",
"telephone_number": "262-532-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINGSMORE",
"first_name": "KONNOR",
"middle_name": "GERALD",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-11-25",
"last_updated": "2024-11-25",
"certification_date": "2024-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "3219-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menomonee Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.