Active NPI
Olivia Vita-Farnsworth, MS, LAT, ATC
- Athletic Trainer
- Mississippi State, MS
National Provider Identifier
1497163422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A992
- Practice address
- 288 Lakeview Drive
Mississippi State, MS 39762 - Phone
- (662) 325-2165
- Fax
- (662) 325-5145
- NPI assigned
- Jul 22, 2014
- Last updated
- Jul 3, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126003204 | VA | |
| Athletic Trainer | 2255A2300X | A992 | MS | Primary |
Addresses
Primary practice location
288 Lakeview Drive
Mississippi State, MS 39762
Mailing address
PO Box 5327
Mississippi State, MS 39762-5327
Phone (662) 325-2165
Other practice location 1
4400 University Dr
Fairfax, VA 22030
Phone (703) 993-3277
Other practice location 2
4400 University Dr
Fairfax, VA 22030
Phone (703) 993-3277
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A992 | MS | MD | Athletic Trainer |
| 0126003204 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593734400000",
"number": "1497163422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5327",
"city": "MISSISSIPPI STATE",
"state": "MS",
"postal_code": "397625327",
"telephone_number": "662-325-2165",
"fax_number": "662-325-5145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "288 LAKEVIEW DRIVE",
"city": "MISSISSIPPI STATE",
"state": "MS",
"postal_code": "39762",
"telephone_number": "662-325-2165",
"fax_number": "662-325-5145"
}
],
"practiceLocations": [
{
"address_1": "4400 University Dr",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "VA",
"postal_code": "22030",
"country_code": "US",
"telephone_number": "703-993-3277",
"fax_number": "703-993-3360",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4400 University Dr",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "VA",
"postal_code": "22030",
"country_code": "US",
"telephone_number": "703-993-3277",
"fax_number": "703-993-3360",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VITA-FARNSWORTH",
"first_name": "OLIVIA",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-22",
"last_updated": "2020-07-03",
"certification_date": "2020-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126003204",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MS",
"license": "A992",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mississippi State, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.