Shae E Anderson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2014012710 Issued in MO

Practice address

4331 S Fremont Ave
Springfield, MO 65804-7328

Phone

(417) 820-5010

NPI assigned

Dec 24, 2014

Last updated

Dec 24, 2014By 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 1

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": "1419379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419379200000",
    "number": "1346638426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 E GRAND ST",
            "address_2": "APT 4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658071655",
            "telephone_number": "618-210-3940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4331 S FREMONT AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047328",
            "telephone_number": "417-820-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SHAE",
        "middle_name": "E",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-24",
        "last_updated": "2014-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2014012710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loretta Lee Anderson, LCSW
• Margaret Ann Anderson
• Mark D Anderson, MD
• Melissa Anderson, P.A.-C
• Robin Noel Anderson, RN
• Shane Lyn Anderson, MA-PLPC
• Susan Lynn Anderson, MA LPC
• Teresa Renee Anderson
• Todd Douglas Anderson, D.D.S.
• Adam C. Andreassen, PSY. D, LP

• Athletic Trainer in Springfield, MO
• Providers in Springfield, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2014; 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.