Kyle Diedrich Kutsup, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00184400 Issued in NJ

Practice address

35 Conestoga TRL
Sparta, NJ 07871-2507

Phone

(973) 460-7708

NPI assigned

Jan 7, 2022

Sex

Male

Sole proprietor

No

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

State licenses

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

{
    "created_epoch": "1641513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641513600000",
    "number": "1730840141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 CONESTOGA TRL",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712507",
            "telephone_number": "973-460-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 CONESTOGA TRL",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078712507",
            "telephone_number": "973-460-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTSUP",
        "first_name": "KYLE",
        "middle_name": "DIEDRICH",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-07",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00184400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra E Koss, M.D.
• Kayla Kostecki, LAC
• Stephen Alan Kowalsky, OD
• Shannon Kuratli
• Elizabeth Kussler
• Tyler Laib, DPT
• Lakeside Counseling Associates, LLC
• Jennifer Lynn Lamphier, D.M.D
• Joseph Steven Larena, FNP-C
• Madison A Lau

• Athletic Trainer in Sparta, NJ
• Providers in Sparta, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; 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.