Active NPI
Keith Allen Peltier Jr., ATC LAT
- Athletic Trainer
- Harrogate, TN
National Provider Identifier
1437786381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2288
- Practice address
- 6965 Cumberland Gap Pkwy
Harrogate, TN 37752-8231 - Phone
- (423) 869-6560
- NPI assigned
- Mar 23, 2020
- 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 | 2288 | TN | Primary |
Addresses
Primary practice location
6965 Cumberland Gap Pkwy
Harrogate, TN 37752-8231
Mailing address
6965 Cumberland Gap Pkwy
Harrogate, TN 37752-8231
Phone (423) 869-6560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2288 | Other | TN | ATHLETIC TRAINER |
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 |
|---|---|---|---|
| 2288 | TN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584921600000",
"number": "1437786381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6965 CUMBERLAND GAP PKWY",
"city": "HARROGATE",
"state": "TN",
"postal_code": "377528231",
"telephone_number": "423-869-6560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6965 CUMBERLAND GAP PKWY",
"city": "HARROGATE",
"state": "TN",
"postal_code": "377528231",
"telephone_number": "423-869-6560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELTIER",
"first_name": "KEITH",
"middle_name": "ALLEN",
"name_suffix": "Jr.",
"credential": "ATC LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-23",
"last_updated": "2020-03-23",
"certification_date": "2020-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2288",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "2288",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harrogate, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.