Kenneth Riley Hickman, ATC

Key facts

NPI

1487609129

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

36000117A (IN)

Practice address

1104 East Grace St
Jasper County Hospital
Rensselaer, IN 47978-3211

Phone

(219) 866-5141

Fax

(219) 866-3234

NPI assigned

May 23, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 13, 2026.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1487609129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 EAST GRACE ST",
            "city": "RENSSELAER",
            "state": "IN",
            "postal_code": "479783211",
            "telephone_number": "219-866-5141",
            "fax_number": "219-866-3234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 EAST GRACE ST",
            "address_2": "JASPER COUNTY HOSPITAL",
            "city": "RENSSELAER",
            "state": "IN",
            "postal_code": "479783211",
            "telephone_number": "219-866-5141",
            "fax_number": "219-866-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "KENNETH",
        "middle_name": "RILEY",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36000117A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Rensselaer, IN · Athletic Trainer in Indiana