Active NPI
Shawn Fayard, ATC
- Athletic Trainer
- Hattiesburg, MS
National Provider Identifier
1689908352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT0472
- Practice address
- 103 Medical Park
Hattiesburg, MS 39401-9042 - Phone
- (601) 268-5630
- NPI assigned
- Sep 28, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | AT0472 | MS | Primary |
Addresses
Primary practice location
103 Medical Park
Hattiesburg, MS 39401-9042
Mailing address
PO Box 778
Purvis, MS 39475-0778
Other practice location 1
149 Drinkwater Rd
Bay St Louis, MS 39520-1658
Phone (228) 467-8725
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010702011 | Other | MS | NATIONAL ATHLETIC TRAINER'S ASSOCIATION BOARD OF CERTIFICATION (NATABOC) |
| AT0472 | Other | MS | MISSISSIPPI DEPARTMENT OF HEALTH LICENSURE |
| 1005471 | Other | MS | NATIONAL ATHLETIC TRAINER'S ASSOCIATION (NATA) |
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 |
|---|---|---|---|
| AT0472 | MS | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603152000000",
"number": "1689908352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 778",
"city": "PURVIS",
"state": "MS",
"postal_code": "394750778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 MEDICAL PARK",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394019042",
"telephone_number": "601-268-5630"
}
],
"practiceLocations": [
{
"address_1": "149 Drinkwater Rd",
"address_purpose": "LOCATION",
"city": "Bay St Louis",
"state": "MS",
"postal_code": "395201658",
"country_code": "US",
"telephone_number": "228-467-8725",
"fax_number": "228-467-8724",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FAYARD",
"first_name": "SHAWN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-28",
"last_updated": "2020-10-20",
"certification_date": "2020-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MS",
"license": "AT0472",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL ATHLETIC TRAINER'S ASSOCIATION BOARD OF CERTIFICATION (NATABOC)",
"identifier": "010702011",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSISSIPPI DEPARTMENT OF HEALTH LICENSURE",
"identifier": "AT0472",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL ATHLETIC TRAINER'S ASSOCIATION (NATA)",
"identifier": "1005471",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.