Kimberly Tevis, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A1 60134292 Issued in WA

Practice address

16515 Meridian E
Suite 202B
Puyallup, WA 98375-6251

Phone

(253) 840-5511

Fax

(253) 840-0835

NPI assigned

May 13, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1528446200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16515 MERIDIAN E",
            "address_2": "SUITE 202B",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983756251",
            "telephone_number": "253-840-5511",
            "fax_number": "253-840-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16515 MERIDIAN E",
            "address_2": "SUITE 202B",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983756251",
            "telephone_number": "253-840-5511",
            "fax_number": "253-840-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEVIS",
        "first_name": "KIMBERLY",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-13",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WA",
            "license": "A1 60134292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.