Active NPI
Tim Driedric
- Athletic Trainer
- Little Rock, AR
National Provider Identifier
1386091031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 618
- Practice address
- 3400 S. Bowman Rd. Apt 812
Little Rock, AR 72211 - Phone
- (501) 351-4185
- NPI assigned
- May 23, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 618 | AR | Primary |
Addresses
Primary practice location
3400 S. Bowman Rd. Apt 812
Little Rock, AR 72211
Mailing address
3400 S Bowman Rd Apt 812
Little Rock, AR 72211-4657
Phone (501) 351-4185
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 |
|---|---|---|---|
| 618 | AR | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463961600000",
"number": "1386091031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 S BOWMAN RD APT 812",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722114657",
"telephone_number": "501-351-4185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 S. BOWMAN RD. APT 812",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "72211",
"telephone_number": "501-351-4185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRIEDRIC",
"first_name": "TIM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-23",
"last_updated": "2016-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.