Amber Renae Dodson, MED, ATC – Athletic Trainer

Key facts

NPI: 1356562326
Entity type: Individual (NPI type 1)
Primary specialty: Athletic Trainer 2255A2300X
License: 2004022306 (MO)
Practice address: 1 University Ave
Fulton, MO 65251-2388
Phone: (573) 592-4398
Fax: (573) 592-4386
NPI assigned: May 1, 2007
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

William Woods University Athletic Training Services Athletic Trainer · Fulton, MO · NPI 1114105327

NPD (past) ATHLETIC TRAINER

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Education

State licenses

License	State	Type	Specialty
2004022306	MO	MD	Athletic Trainer

Practice roles

Organization	Specialty	Status	New patients
William Woods University Athletic Training Services	Athletic Trainer	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Athletic Trainer	2255A2300X	2004022306	MO	Yes

Addresses

Primary practice location

1 University Ave
Fulton, MO 65251-2388

Mailing address

1 University Ave
Fulton, MO 65251-2388
Phone (573) 592-4398

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 11, 2008.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1356562326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY AVE",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512388",
            "telephone_number": "573-592-4398",
            "fax_number": "573-592-4386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY AVE",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512388",
            "telephone_number": "573-592-4398",
            "fax_number": "573-592-4386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODSON",
        "first_name": "AMBER",
        "middle_name": "RENAE",
        "name_prefix": "Ms.",
        "credential": "MED, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2004022306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MO

All providers in Fulton, MO · Athletic Trainer in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.