Active NPI
Kimberly Ann Blackburn, ATC
- Athletic Trainer
- Cleveland Heights, OH
National Provider Identifier
1790748713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-015
- Practice address
- 3301 N Park Blvd
Beaumont School
Cleveland Heights, OH 44118-4258 - Phone
- (440) 223-3292
- NPI assigned
- Apr 10, 2006
- 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-015 | OH | Primary |
Addresses
Primary practice location
3301 N Park Blvd
Beaumont School
Cleveland Heights, OH 44118-4258
Mailing address
11694 Prospect Rd
Strongsville, OH 44149-2928
Phone (440) 572-0126
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-015 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378166400000",
"number": "1790748713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11694 PROSPECT RD",
"city": "STRONGSVILLE",
"state": "OH",
"postal_code": "441492928",
"telephone_number": "440-572-0126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 N PARK BLVD",
"address_2": "BEAUMONT SCHOOL",
"city": "CLEVELAND HEIGHTS",
"state": "OH",
"postal_code": "441184258",
"telephone_number": "440-223-3292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-10",
"last_updated": "2013-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.