Active NPI
Tyler Ren Wickett, ATC
- Athletic Trainer
- Marquette, MI
National Provider Identifier
1336649409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601001755
- Practice address
- 1401 Presque Isle Ave
Marquette, MI 49855-2818 - Phone
- (360) 593-1714
- NPI assigned
- Feb 15, 2018
- 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 | 2601001755 | MI | Primary |
Addresses
Primary practice location
1401 Presque Isle Ave
Marquette, MI 49855-2818
Mailing address
303 Meyland Hall
Marquette, MI 49855-5391
Phone (360) 593-1714
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 |
|---|---|---|---|
| 2601001755 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518652800000",
"number": "1336649409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 MEYLAND HALL",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498555391",
"telephone_number": "360-593-1714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 PRESQUE ISLE AVE",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498552818",
"telephone_number": "360-593-1714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKETT",
"first_name": "TYLER",
"middle_name": "REN",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-15",
"last_updated": "2018-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601001755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marquette, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.