Active NPI
Dianna Kisner, AT
- Athletic Trainer
- Grand Rapids, MI
National Provider Identifier
1538401690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- L1890453
- Practice address
- 160 68TH St SW
Grand Rapids, MI 49548-7114 - Phone
- (616) 455-3210
- NPI assigned
- Mar 26, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | L1890453 | MI | Primary |
Addresses
Primary practice location
160 68TH St SW
Grand Rapids, MI 49548-7114
Mailing address
4623 Poinsettia Ave SE
Kentwood, MI 49508-4505
Phone (616) 893-6918
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 |
|---|---|---|---|
| L1890453 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364256000000",
"number": "1538401690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4623 POINSETTIA AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495084505",
"telephone_number": "616-893-6918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 68TH ST SW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495487114",
"telephone_number": "616-455-3210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISNER",
"first_name": "DIANNA",
"credential": "AT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-26",
"last_updated": "2013-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "L1890453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.