Active NPI
Avery Brianne Carlson, ATC, LAT
- Athletic Trainer
- Nampa, ID
National Provider Identifier
1669862884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-531
- Practice address
- 36 5TH St N
Nampa, ID 83687-3482 - Phone
- (605) 880-8886
- NPI assigned
- Jan 26, 2015
- Sex
- Female
- 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 | AT-531 | ID | Primary |
Addresses
Primary practice location
36 5TH St N
Nampa, ID 83687-3482
Mailing address
36 5TH St N
Nampa, ID 83687-3482
Phone (605) 880-8886
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 |
|---|---|---|---|
| AT-531 | ID | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422230400000",
"number": "1669862884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 5TH ST N",
"city": "NAMPA",
"state": "ID",
"postal_code": "836873482",
"telephone_number": "605-880-8886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 5TH ST N",
"city": "NAMPA",
"state": "ID",
"postal_code": "836873482",
"telephone_number": "605-880-8886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "AVERY",
"middle_name": "BRIANNE",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-26",
"last_updated": "2015-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ID",
"license": "AT-531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.