Nicholas Peters, ATC, AT, M.ED

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

319272 Issued in TN

Practice address

650 Joel Dr
Fort Campbell, KY 42223-5318

Phone

(989) 225-2274

NPI assigned

Feb 2, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1588022842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "989-225-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "989-225-2274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817 17th St",
            "address_purpose": "LOCATION",
            "city": "Bay City",
            "state": "MI",
            "postal_code": "487087228",
            "country_code": "US",
            "telephone_number": "989-225-2274",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4090 Geddes Rd",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481052750",
            "country_code": "US",
            "telephone_number": "989-225-2274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "NICHOLAS",
        "credential": "ATC, AT, M.ED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-02",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": "319272",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601001929",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Frank Peacock, PA-C
• Samuel M Peik, M.D.
• Bradley Pendley
• Lucas Pepper, DMD
• Cynthia Perry, DO
• Amanda Mae Peterson, CNM, WHNP-BC
• Christopher Alyn Peterson, PA-C
• Kimberley Ann Peterson, MSW, LICSW
• Rachel Elaine Peterson, LCSW
• Michael Carroll Petitt, RPH, PHARM.D.

• Athletic Trainer in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Athletic Trainer in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; 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.