Active NPI
Stephanie Medina, ATC
- Athletic Trainer
- Nacogdoches, TX
National Provider Identifier
1609320571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000026122
- Practice address
- 1936 North St
Nacogdoches, TX 75965-3940 - Phone
- (936) 468-4550
- NPI assigned
- Aug 9, 2016
- 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 | 2000026122 | CA | Primary |
Addresses
Primary practice location
1936 North St
Nacogdoches, TX 75965-3940
Mailing address
1936 North St
Nacogdoches, TX 75965-3940
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 |
|---|---|---|---|
| 2000026122 | CA | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephen F Austin State University Sports Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Student Health Clinic/Center
- Nacogdoches, TX
- NPI 1063727048
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470700800000",
"number": "1609320571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1936 NORTH ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759653940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1936 NORTH ST",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759653940",
"telephone_number": "936-468-4550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "STEPHANIE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-09",
"last_updated": "2016-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "2000026122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.