Active NPI
Stephen Curtis Wilkerson, ATC
- Athletic Trainer
- Belleville, IL
National Provider Identifier
1548613300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.002996
- Practice address
- 2600 W Main St
Belleville, IL 62226-6651 - Phone
- (618) 239-6109
- NPI assigned
- Jul 18, 2016
- Last updated
- Jul 18, 2016
- 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 | 096.002996 | IL | Primary |
Addresses
Primary practice location
2600 W Main St
Belleville, IL 62226-6651
Mailing address
2724 Granda Dr
Saint Louis, MO 63125-4022
Phone (314) 550-9390
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 |
|---|---|---|---|
| 096.002996 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468800000000",
"number": "1548613300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2724 GRANDA DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631254022",
"telephone_number": "314-550-9390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 W MAIN ST",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622266651",
"telephone_number": "618-239-6109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKERSON",
"first_name": "STEPHEN",
"middle_name": "CURTIS",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-18",
"last_updated": "2016-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.002996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.