Blake Alexander Smith, LAT, ATC, MS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

24-01112 Issued in KS

Practice address

125 S 2ND St
Arkansas City, KS 67005-2662

Phone

(620) 687-1680

NPI assigned

Dec 31, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1699362012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S 2ND ST",
            "city": "ARKANSAS CITY",
            "state": "KS",
            "postal_code": "670052662",
            "telephone_number": "620-687-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S 2ND ST",
            "city": "ARKANSAS CITY",
            "state": "KS",
            "postal_code": "670052662",
            "telephone_number": "620-687-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BLAKE",
        "middle_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "credential": "LAT, ATC, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-31",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KS",
            "license": "24-01112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael R Schumacher, PA
• Lori Ann Schwartz, APRN, FNP-BC
• John D Seitz, D.D.S
• Kamran Shahzada, M.D.
• Randy Simpson, PA
• Madeline Smith, OD
• Daniel J Snowden, DDS
• South Central Kansas Clinic LLC
• South Central Kansas Clinic LLC
• South Central Kansas Regional Medical Center

• Athletic Trainer in Arkansas City, KS
• Providers in Arkansas City, KS by specialty
• Athletic Trainer in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.

Verify at the official NPI Registry.