Active NPI
Michael Wayne Shetley, ATC, CSCS
- Athletic Trainer
- Appomattox, VA
National Provider Identifier
1346594264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126000490
- Practice address
- 198 Evergreen Ave
Appomattox, VA 24522 - Phone
- (804) 539-5080
- NPI assigned
- Oct 30, 2012
- Last updated
- Oct 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 | 0126000490 | VA | Primary |
Addresses
Primary practice location
198 Evergreen Ave
Appomattox, VA 24522
Mailing address
179 Glenn Carson Rd
Prospect, VA 23960-2112
Phone (804) 539-5080
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 |
|---|---|---|---|
| 0126000490 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1346594264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "179 GLENN CARSON RD",
"city": "PROSPECT",
"state": "VA",
"postal_code": "239602112",
"telephone_number": "804-539-5080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "198 EVERGREEN AVE",
"city": "APPOMATTOX",
"state": "VA",
"postal_code": "24522",
"telephone_number": "804-539-5080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHETLEY",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "ATC, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-30",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126000490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appomattox, VA
- Meredith Quarles, PA-C
- Rector & Visitors of the University of Virginia (UVA-Appomattox Dialysis)
- Regal Medical Services, LTD.
- Tiffany Ross, RPH
- Victoria Ann Seal, HOME HEALTH LICENSE
- Katrina Archer Slagle, PMHNP-BC
- Lisa W Smith, RPH
- Pamela Kaye Smith, MED, CEAP
- Jarred Alexander Sowards, PHARM. D.
- Kimberly Steger, LPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.