Kelson James Wann, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000010439 Issued in NU

Practice address

285 Forest Grove Dr Ste 207
Pewaukee, WI 53072-3738

Phone

(877) 732-2262

NPI assigned

Feb 19, 2018

Last updated

Feb 19, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518998400000",
    "number": "1861992570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 FOREST GROVE DR STE 207",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530723738",
            "telephone_number": "877-732-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 FOREST GROVE DR STE 207",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530723738",
            "telephone_number": "877-732-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANN",
        "first_name": "KELSON",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "MS, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-19",
        "last_updated": "2018-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": "2000010439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; 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.