Active NPI
Tyler Nusbaum
- Athletic Trainer
- Clarksville, TN
National Provider Identifier
1508429432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2381
- Practice address
- 200 S Hampton PL
Clarksville, TN 37040-6359 - Phone
- (419) 518-0395
- NPI assigned
- Apr 16, 2019
- 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 | 2381 | TN | Primary |
Addresses
Primary practice location
200 S Hampton PL
Clarksville, TN 37040-6359
Mailing address
216 Ohio Dr
Bryan, OH 43506-8944
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 |
|---|---|---|---|
| 2381 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1508429432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 OHIO DR",
"city": "BRYAN",
"state": "OH",
"postal_code": "435068944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S HAMPTON PL",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370406359",
"telephone_number": "419-518-0395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUSBAUM",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-16",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.