Active NPI
Kelsey Petz
- Athletic Trainer
- Jefferson City, TN
National Provider Identifier
1881113918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2502
- Practice address
- 2130 Branner Ave
Jefferson City, TN 37760-2210 - Phone
- (970) 817-1974
- NPI assigned
- Sep 9, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | 2502 | TN | Primary |
Addresses
Primary practice location
2130 Branner Ave
Jefferson City, TN 37760-2210
Mailing address
1988 Kidwell Ridge Rd
Morristown, TN 37814-1724
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 |
|---|---|---|---|
| 2502 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664409600000",
"number": "1881113918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1988 KIDWELL RIDGE RD",
"city": "MORRISTOWN",
"state": "TN",
"postal_code": "378141724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 BRANNER AVE",
"city": "JEFFERSON CITY",
"state": "TN",
"postal_code": "377602210",
"telephone_number": "970-817-1974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETZ",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-09",
"last_updated": "2022-09-29",
"certification_date": "2022-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, TN
- Shasta Patrick, NP
- Patriot Center for Hearing Loss & Related Disorders, LLC (Happy Hearing, LLC)
- Christina Isabelle Patterson, BS/RDH
- Lance S Patton, M.D.
- People2Places
- Joshua Porter, M.D.
- Erica Denise Powell
- Neil Edward Pressley, APRN-BC
- Priority Senior Care LLC
- R&M Pharmacy LLC. (Murphy's Sav-Mor Pharmacy,Inc.)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.