Active NPI
Tina M Hackley, ATC
- Athletic Trainer
- Columbia Heights, MN
National Provider Identifier
1316002066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1731
- Practice address
- 1400 49TH Ave NE
Columbia Heights, MN 55421-1939 - Phone
- (612) 839-0249
- NPI assigned
- Dec 22, 2006
- Last updated
- Feb 10, 2016
- 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 | 1731 | MN | Primary |
Addresses
Primary practice location
1400 49TH Ave NE
Columbia Heights, MN 55421-1939
Mailing address
10907 Kentucky Ave N
Champlin, MN 55316-3823
Phone (612) 839-0249
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 |
|---|---|---|---|
| 1731 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455062400000",
"number": "1316002066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10907 KENTUCKY AVE N",
"city": "CHAMPLIN",
"state": "MN",
"postal_code": "553163823",
"telephone_number": "612-839-0249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 49TH AVE NE",
"city": "COLUMBIA HEIGHTS",
"state": "MN",
"postal_code": "554211939",
"telephone_number": "612-839-0249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKLEY",
"first_name": "TINA",
"middle_name": "M",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-22",
"last_updated": "2016-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "1731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia Heights, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.