Active NPI
Michael Lycan, LAT, ATC
- Athletic Trainer
- Lake Stevens, WA
National Provider Identifier
1821662362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A160711532
- Practice address
- 8217 17TH St SE
Lake Stevens, WA 98258-3839 - Phone
- (503) 930-1828
- NPI assigned
- May 19, 2021
- 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 | A160711532 | WA | Primary |
Addresses
Primary practice location
8217 17TH St SE
Lake Stevens, WA 98258-3839
Mailing address
8217 17TH St SE
Lake Stevens, WA 98258-3839
Phone (503) 930-1828
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 |
|---|---|---|---|
| A160711532 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1821662362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8217 17TH ST SE",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "982583839",
"telephone_number": "503-930-1828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8217 17TH ST SE",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "982583839",
"telephone_number": "503-930-1828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYCAN",
"first_name": "MICHAEL",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-19",
"last_updated": "2021-05-19",
"certification_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A160711532",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Stevens, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.