Active NPI
Marisa Warren, LAT, ATC
- Athletic Trainer
- Spring Lake, NC
National Provider Identifier
1659829638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 2495 Ray Rd
Spring Lake, NC 28390-7531 - Phone
- (910) 436-1436
- NPI assigned
- Sep 19, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | LAT-3011 | NC | |
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
2495 Ray Rd
Spring Lake, NC 28390-7531
Mailing address
1006 W Lady Diana CT
Apex, NC 27502-9260
Phone (919) 616-8690
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LAT-3011 | Other | NC | NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS |
| 2000024503 | Other | NC | BOARD OF CERTIFICATION CERTIFIED ATHLETIC TRAINER |
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 |
|---|---|---|---|
| LAT-3011 | NC | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1659829638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1006 W LADY DIANA CT",
"city": "APEX",
"state": "NC",
"postal_code": "275029260",
"telephone_number": "919-616-8690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2495 RAY RD",
"city": "SPRING LAKE",
"state": "NC",
"postal_code": "283907531",
"telephone_number": "910-436-1436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARREN",
"first_name": "MARISA",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-19",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "NC",
"license": "LAT-3011",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS",
"identifier": "LAT-3011",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF CERTIFICATION CERTIFIED ATHLETIC TRAINER",
"identifier": "2000024503",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spring Lake, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.