Kelli Anne Plemmons, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126003154 Issued in VA

Practice address

1460 University Dr
Winchester, VA 22601-5195

Phone

(540) 545-6505

NPI assigned

May 22, 2019

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

• Kelli Anne Thiederman 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": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1386201648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 W MASTERS DR",
            "city": "CROSS JUNCTION",
            "state": "VA",
            "postal_code": "226252447",
            "telephone_number": "509-531-3712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 UNIVERSITY DR",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226015195",
            "telephone_number": "540-545-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLEMMONS",
        "first_name": "KELLI",
        "middle_name": "ANNE",
        "credential": "ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126003154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "THIEDERMAN",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Athletic Trainer in Winchester, VA
• Providers in Winchester, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.