Active NPI
Edrian J Hairston, MS ATC LAT
- Athletic Trainer
- Deland, FL
National Provider Identifier
1720255847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL 2455
- Practice address
- Stetson University 421 N Woodland Blvd
Unit 8317
Deland, FL 32723-0001 - Phone
- (386) 822-7166
- NPI assigned
- May 8, 2008
- 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 | AL 2455 | FL | Primary |
Addresses
Primary practice location
Stetson University 421 N Woodland Blvd
Unit 8317
Deland, FL 32723-0001
Mailing address
401 W Seminole Blvd
Apt 150
Sanford, FL 32771-1200
Phone (386) 822-7166
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL 2455 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1720255847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 W SEMINOLE BLVD",
"address_2": "APT 150",
"city": "SANFORD",
"state": "FL",
"postal_code": "327711200",
"telephone_number": "386-822-7166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STETSON UNIVERSITY 421 N WOODLAND BLVD",
"address_2": "UNIT 8317",
"city": "DELAND",
"state": "FL",
"postal_code": "327230001",
"telephone_number": "386-822-7166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAIRSTON",
"first_name": "EDRIAN",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "MS ATC LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-08",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL 2455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.