Active NPI
Michael Keith Smith, LAT, ATC
- Athletic Trainer
- Las Vegas, NV
National Provider Identifier
1609318369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0506411
- Practice address
- 821 N Nellis Blvd
Las Vegas, NV 89110-5339 - Phone
- (702) 452-4563
- NPI assigned
- Nov 12, 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 | 0506411 | NV | Primary |
Addresses
Primary practice location
821 N Nellis Blvd
Las Vegas, NV 89110-5339
Mailing address
821 N Nellis Blvd
Las Vegas, NV 89110-5339
Phone (702) 452-4563
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 |
|---|---|---|---|
| 0506411 | NV | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478908800000",
"number": "1609318369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 N NELLIS BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891105339",
"telephone_number": "702-452-4563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 N NELLIS BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891105339",
"telephone_number": "702-452-4563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "MICHAEL",
"middle_name": "KEITH",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-12",
"last_updated": "2016-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NV",
"license": "0506411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.