Brent Walters, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001087 Issued in WV

Practice address

200 High St
Glenville, WV 26351-1200

Phone

(304) 462-6223

NPI assigned

Apr 25, 2012

Last updated

Apr 25, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

• Glenville State University

  • Student Health Clinic/Center
  • Glenville, WV
  • NPI 1982979548
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335312000000",
    "number": "1376801670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HIGH ST",
            "city": "GLENVILLE",
            "state": "WV",
            "postal_code": "263511200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HIGH ST",
            "city": "GLENVILLE",
            "state": "WV",
            "postal_code": "263511200",
            "telephone_number": "304-462-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "BRENT",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WV",
            "license": "AT001087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• June Julie Turner, N.D.
• Joann Tymeson, MPT
• Diana Vance
• Walgreen Co (Walgreens #18366)
• Walgreen Co. (Walgreens #18366)
• Shirley Weaver
• John C Westfall, DDS
• April Whipkey
• Halee Noelle Wildman
• Christeen Williams

• Athletic Trainer in Glenville, WV
• Providers in Glenville, WV by specialty
• Athletic Trainer in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.

Verify at the official NPI Registry.