Kristin Leeann Wilson, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

004899 Issued in NY

Practice address

10529 S Riva Ridge Loop
Fort Drum, NY 13602

Phone

(325) 650-6489

Fax

(325) 650-6489

NPI assigned

Nov 15, 2017

Last updated

Dec 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1336652080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99068 MOUNTAIN VIEW DR UNIT A",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136033612",
            "telephone_number": "325-650-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10529 S RIVA RIDGE LOOP",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "325-650-6489",
            "fax_number": "325-650-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KRISTIN",
        "middle_name": "LEEANN",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-15",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "6857",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "004899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luther Roswell Wiest, D.O.
• Mechia M. Williams, LCSW
• Kathleen Willis-Farmer, RDH
• Roy Wilms, R.N.
• Keith Jonathan Wilson, DDS
• Jonah Sidney Winakor, MD
• Anton Roy Wineman Jr., PA-C
• Tara E Wise, M.S., O.T.R./L
• Han Yi Woo, FNP
• Juan Latino Woods, PA-C

• Athletic Trainer in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.