Heather Lyn-Nieboer Smith, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601000712 Issued in MI

Practice address

2140 Bauer Rd
Jenison, MI 49428-9539

Phone

(616) 457-8454

Fax

(616) 457-8441

NPI assigned

Sep 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Heather Lyn Nieboer Former name

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": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397865600000",
    "number": "1366637209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 BAUER RD",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494289539",
            "telephone_number": "616-457-8454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 BAUER RD",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494289539",
            "telephone_number": "616-457-8454",
            "fax_number": "616-457-8441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "HEATHER",
        "middle_name": "LYN-NIEBOER",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-13",
        "last_updated": "2014-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "NIEBOER",
            "middle_name": "LYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Madison Simmon
• Joshua Simpson
• Colleen Skuza, M.A., CF-SLP
• Gracen Loraine Smit, LLPC
• Allen Ralph Smith, O.D.
• Logan Conrad Smith, DDS
• Natalie Smith
• Scott Edward Sorensen, R.PH.
• Space for Change Therapeutic Services, LLC
• Megan Spangler

• Athletic Trainer in Jenison, MI
• Providers in Jenison, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.