Active NPI
Krisjan Mikkel Henderson, MAT, LAT, ATC
- Athletic Trainer
- Waterloo, IA
National Provider Identifier
1831880152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 133126
- Practice address
- 604 Ansborough Ave
Waterloo, IA 50701-5842 - Phone
- (319) 433-0130
- NPI assigned
- May 17, 2023
- 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 | 133126 | IA | Primary |
Addresses
Primary practice location
604 Ansborough Ave
Waterloo, IA 50701-5842
Mailing address
1106 Kent Cir Apt 7
Waterloo, IA 50701-4479
Phone (515) 829-6540
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 |
|---|---|---|---|
| 133126 | IA | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletico LTD | Single Specialty | Past | Accepting new patients |
| Athletico LTD | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Lafayette, IN
- NPI 1053044867
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750723200000",
"number": "1831880152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1106 KENT CIR APT 7",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507014479",
"telephone_number": "515-829-6540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 ANSBOROUGH AVE",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507015842",
"telephone_number": "319-433-0130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KRISJAN",
"middle_name": "MIKKEL",
"credential": "MAT, LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-17",
"last_updated": "2025-06-24",
"certification_date": "2025-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IA",
"license": "133126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.