Active NPI
Debra Willardson, ATC
- Other Specialist/Technologist
- Salt Lake City, UT
National Provider Identifier
1467513713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- License
- 1216584810
- Practice address
- 1825 E South Campus Dr
Athletics Dept.
Salt Lake City, UT 84112-0900 - Phone
- (801) 581-4836
- Fax
- (801) 585-5005
- NPI assigned
- Dec 12, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | 1216584810 | UT | Primary |
Addresses
Primary practice location
1825 E South Campus Dr
Athletics Dept.
Salt Lake City, UT 84112-0900
Mailing address
1825 E South Campus Dr
Atheltics Dept.
SLC, UT 84112-0900
Phone (801) 581-4836
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2255A2300X | Other | UT | 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 |
|---|---|---|---|
| 1216584810 | UT | MD | Other Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467513713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 E SOUTH CAMPUS DR",
"address_2": "ATHELTICS DEPT.",
"city": "SLC",
"state": "UT",
"postal_code": "841120900",
"telephone_number": "801-581-4836",
"fax_number": "801-585-5005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 E SOUTH CAMPUS DR",
"address_2": "ATHLETICS DEPT.",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841120900",
"telephone_number": "801-581-4836",
"fax_number": "801-585-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARDSON",
"first_name": "DEBRA",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": "UT",
"license": "1216584810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "2255A2300X",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.