Active NPI
Kesenya Havlicek
- Athletic Trainer
- Woodbury, MN
National Provider Identifier
1316567886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 4040 Radio Dr
Woodbury, MN 55129-3237 - Phone
- (651) 439-8807
- NPI assigned
- Apr 24, 2020
- Last updated
- May 9, 2022
- 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 | NU | Primary |
Addresses
Primary practice location
4040 Radio Dr
Woodbury, MN 55129-3237
Mailing address
740 W 229TH St
Jordan, MN 55352-9459
Other practice location 1
740 W 229th St
Jordan, MN 55352-9459
Phone (952) 686-4458
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652054400000",
"number": "1316567886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "740 W 229TH ST",
"city": "JORDAN",
"state": "MN",
"postal_code": "553529459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4040 RADIO DR",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551293237",
"telephone_number": "651-439-8807"
}
],
"practiceLocations": [
{
"address_1": "740 W 229th St",
"address_purpose": "LOCATION",
"city": "Jordan",
"state": "MN",
"postal_code": "553529459",
"country_code": "US",
"telephone_number": "952-686-4458",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HAVLICEK",
"first_name": "KESENYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-24",
"last_updated": "2022-05-09",
"certification_date": "2022-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.