Nicholas Meniettti, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

116052 Issued in AK

Practice address

1725 University Ave S
Apt D45
Fairbanks, AK 99709-4932

Phone

(618) 972-0274

NPI assigned

Jul 11, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

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": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1831541184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 UNIVERSITY AVE S",
            "address_2": "APT D45",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094932",
            "telephone_number": "618-972-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 UNIVERSITY AVE S",
            "address_2": "APT D45",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094932",
            "telephone_number": "618-972-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENIETTTI",
        "first_name": "NICHOLAS",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096003696",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RTO000174",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AK",
            "license": "116052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Mellard, MA
• Hope Melnichuk
• Vladimir Melnichuk
• Dirk S Menard, DMD
• Isabella Mendez
• Karin Michelle Mensing, MA
• Luzviminda Mercado
• Rachael Mercado
• Neidra Dawn Merrill
• Alexander Colley Merritt, MD

• Athletic Trainer in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Athletic Trainer in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; 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.