Active NPI
Kelly Rider, ATC, CSCS
- Athletic Trainer
- Glenmont, NY
National Provider Identifier
1831519461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 67 001567
- Practice address
- 15 Chrisken Dr
Glenmont, NY 12077-3249 - Phone
- (518) 598-3973
- NPI assigned
- Apr 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 67 001567 | NY | Primary |
| Athletic Trainer | 2255A2300X | 1958 | MA |
Addresses
Primary practice location
15 Chrisken Dr
Glenmont, NY 12077-3249
Mailing address
15 Chrisken Dr
Glenmont, NY 12077-3249
Phone (518) 598-3973
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 |
|---|---|---|---|
| 1958 | MA | MD | Registered Dietitian |
| 67 001567 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398124800000",
"number": "1831519461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 CHRISKEN DR",
"city": "GLENMONT",
"state": "NY",
"postal_code": "120773249",
"telephone_number": "518-598-3973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 CHRISKEN DR",
"city": "GLENMONT",
"state": "NY",
"postal_code": "120773249",
"telephone_number": "518-598-3973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDER",
"first_name": "KELLY",
"credential": "ATC, CSCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-22",
"last_updated": "2014-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "67 001567",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "1958",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenmont, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.