Active NPI
Mary Kathryn Martinez
- Athletic Trainer
- Pueblo, CO
National Provider Identifier
1891214557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT.0001957
- Practice address
- 1801 Hollywood Dr
Pueblo, CO 81005-2511 - Phone
- (719) 242-6612
- NPI assigned
- Sep 13, 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 | AT.0001957 | CO | Primary |
Addresses
Primary practice location
1801 Hollywood Dr
Pueblo, CO 81005-2511
Mailing address
251 Bonnymede Rd
Pueblo, CO 81001-1333
Phone (575) 491-1353
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 |
|---|---|---|---|
| AT.0001957 | CO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586304000000",
"number": "1891214557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "251 BONNYMEDE RD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011333",
"telephone_number": "575-491-1353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 HOLLYWOOD DR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810052511",
"telephone_number": "719-242-6612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "MARY",
"middle_name": "KATHRYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-13",
"last_updated": "2020-04-08",
"certification_date": "2020-04-08",
"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": "CO",
"license": "AT.0001957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.