Andrew T Kelly, ATC, NASM-CPT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126000858 Issued in VA

Practice address

254 Monroe Dr
Stanardsville, VA 22973-2852

Phone

(434) 939-9004

NPI assigned

Apr 23, 2021

Last updated

Apr 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Andy Kelly Other name

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": "1619136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1629650130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14649 SPOTSWOOD TRL",
            "city": "RUCKERSVILLE",
            "state": "VA",
            "postal_code": "229683076",
            "telephone_number": "757-753-7453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 MONROE DR",
            "city": "STANARDSVILLE",
            "state": "VA",
            "postal_code": "229732852",
            "telephone_number": "434-939-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ANDREW",
        "middle_name": "T",
        "credential": "ATC, NASM-CPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-23",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126000858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDY",
            "last_name": "KELLY",
            "prefix": "MR.",
            "credential": "ATC, NAMS-CPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Athletic Trainer in Stanardsville, VA
• Providers in Stanardsville, VA by specialty
• Athletic Trainer in Virginia

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

Verify at the official NPI Registry.