Active NPI
Nicholas Braley, ATC, LAT
- Athletic Trainer
- Winston Salem, NC
National Provider Identifier
1437865094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2883
- Practice address
- 134 S Peace Haven Rd
Winston Salem, NC 27104-4418 - Phone
- (336) 765-5546
- NPI assigned
- Jan 26, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | 2883 | NC | Primary |
Addresses
Primary practice location
134 S Peace Haven Rd
Winston Salem, NC 27104-4418
Mailing address
155 Hidden Creek Rd
Winston Salem, NC 27127-9190
Phone (304) 593-3403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2883 | Medicaid | NC |
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 |
|---|---|---|---|
| 2883 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674691200000",
"number": "1437865094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 HIDDEN CREEK RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271279190",
"telephone_number": "304-593-3403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "134 S PEACE HAVEN RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271044418",
"telephone_number": "336-765-5546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRALEY",
"first_name": "NICHOLAS",
"name_prefix": "Mr.",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-26",
"last_updated": "2023-01-26",
"certification_date": "2023-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "2883",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2883",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.