Jason Wimberly, MS, ATC
Individual provider Active NPI Athletic Trainer · Reevesville, SC
NPI 1386967503 · NPPES record last updated Mar 2, 2010
Key facts
- NPI
- 1386967503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 636 (SC)
- Practice address
- 205 Whetsell St
Reevesville, SC 29471-4924 - Phone
- (843) 563-8133
- NPI assigned
- Mar 2, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 636 | SC | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 636 | SC | Yes |
Addresses
Primary practice location
205 Whetsell St
Reevesville, SC 29471-4924
Mailing address
205 Whetsell St
Reevesville, SC 29471-4924
Phone (843) 563-8133
Other providers in Reevesville, SC
All providers in Reevesville, SC · Athletic Trainer in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.