Active NPI
Kenneth Becker, ATC
- Athletic Trainer
- Mountain Home Afb, ID
National Provider Identifier
1598185233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-394
- Practice address
- 366 Gunfighter Ave Ste 498
Mountain Home Afb, ID 83648-5258 - Phone
- (208) 724-4782
- NPI assigned
- Apr 21, 2014
- Sex
- Male
- 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 | AT-394 | ID | Primary |
Addresses
Primary practice location
366 Gunfighter Ave Ste 498
Mountain Home Afb, ID 83648-5258
Mailing address
133 Magnolia Ave SE
Fort Walton Beach, FL 32548-7266
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 |
|---|---|---|---|
| AT-394 | ID | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629676800000",
"number": "1598185233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 MAGNOLIA AVE SE",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325487266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "366 GUNFIGHTER AVE STE 498",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836485258",
"telephone_number": "208-724-4782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKER",
"first_name": "KENNETH",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-21",
"last_updated": "2021-08-23",
"certification_date": "2021-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ID",
"license": "AT-394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home Afb, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.