Kylie Heim, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2013022076 Issued in MO

Practice address

1600 University Ave
Bolivar, MO 65613-2578

Phone

(417) 328-1486

NPI assigned

Dec 27, 2016

Last updated

Dec 27, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1482796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1619412889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 W ALDRICH RD APT 8",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132770",
            "telephone_number": "417-693-2459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656132578",
            "telephone_number": "417-328-1486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIM",
        "first_name": "KYLIE",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-27",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2013022076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI LICENSE",
            "identifier": "2013022076",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jessica Hicks, AT

• Athletic Trainer in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Athletic Trainer in Missouri

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

Verify at the official NPI Registry.