Active NPI
Kyle Patrick, LAT, ATC
- Athletic Trainer
- Phoenix, AZ
National Provider Identifier
1629800784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATR-009462
- Practice address
- 3300 W Camelback Rd
Phoenix, AZ 85017-3030 - Phone
- (412) 605-8765
- NPI assigned
- Aug 16, 2024
- 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 | ATR-009462 | AZ | Primary |
Addresses
Primary practice location
3300 W Camelback Rd
Phoenix, AZ 85017-3030
Mailing address
18183 W Desert Blossom Dr
Goodyear, AZ 85338-5118
Phone (412) 605-8765
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 |
|---|---|---|---|
| ATR-009462 | AZ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723766400000",
"number": "1629800784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18183 W DESERT BLOSSOM DR",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853385118",
"telephone_number": "412-605-8765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 W CAMELBACK RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850173030",
"telephone_number": "412-605-8765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATRICK",
"first_name": "KYLE",
"name_prefix": "Mr.",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-16",
"last_updated": "2024-08-16",
"certification_date": "2024-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "ATR-009462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.