Active NPI
Jesse T Wylie, ATC
- Athletic Trainer
- Meriden, CT
National Provider Identifier
1396862108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000119
- Practice address
- 816 Broad St
Suite 17
Meriden, CT 06450-4350 - Phone
- (203) 238-1334
- NPI assigned
- Mar 25, 2007
- 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 | 000119 | CT | Primary |
Addresses
Primary practice location
816 Broad St
Suite 17
Meriden, CT 06450-4350
Mailing address
33 Old Field Hill Rd
Southbury, CT 06488-3836
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 |
|---|---|---|---|
| 000119 | CT | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425945600000",
"number": "1396862108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 OLD FIELD HILL RD",
"city": "SOUTHBURY",
"state": "CT",
"postal_code": "064883836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "816 BROAD ST",
"address_2": "SUITE 17",
"city": "MERIDEN",
"state": "CT",
"postal_code": "064504350",
"telephone_number": "203-238-1334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYLIE",
"first_name": "JESSE",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-25",
"last_updated": "2015-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "000119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meriden, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.