Active NPI
Kyle Steven Wilson, M.ED., ATC, LAT
- Athletic Trainer
- Las Vegas, NV
National Provider Identifier
1871718544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0506002
- Practice address
- 4505 S Maryland Pkwy
Box 450007
Las Vegas, NV 89154-9900 - Phone
- (702) 895-4037
- NPI assigned
- Apr 16, 2007
- 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 | 0506002 | NV | Primary |
Addresses
Primary practice location
4505 S Maryland Pkwy
Box 450007
Las Vegas, NV 89154-9900
Mailing address
8161 Tone St
Las Vegas, NV 89123-0214
Phone (702) 895-4037
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0506002 | NV | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871718544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8161 TONE ST",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891230214",
"telephone_number": "702-895-4037",
"fax_number": "702-895-4474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4505 S MARYLAND PKWY",
"address_2": "BOX 450007",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891549900",
"telephone_number": "702-895-4037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KYLE",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "M.ED., ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NV",
"license": "0506002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.