Active NPI
Carlyn Samuelson, ATC
- Athletic Trainer
- Williamsburg, KY
National Provider Identifier
1366985475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126002487
- Practice address
- 7000 College Station Dr
Williamsburg, KY 40769-1381 - Phone
- (606) 539-4369
- NPI assigned
- Nov 21, 2016
- Sex
- Female
- 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 | 0126002487 | VA | Primary |
Addresses
Primary practice location
7000 College Station Dr
Williamsburg, KY 40769-1381
Mailing address
PO Box 321
Draper, VA 24324-0321
Phone (540) 250-1445
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 |
|---|---|---|---|
| 0126002487 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479686400000",
"number": "1366985475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 321",
"city": "DRAPER",
"state": "VA",
"postal_code": "243240321",
"telephone_number": "540-250-1445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7000 COLLEGE STATION DR",
"city": "WILLIAMSBURG",
"state": "KY",
"postal_code": "407691381",
"telephone_number": "606-539-4369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELSON",
"first_name": "CARLYN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-21",
"last_updated": "2016-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126002487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamsburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.