Active NPI
Terry R. Kimball, ATC, LAT
- Athletic Trainer
- Lafayette, LA
National Provider Identifier
1891286753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATC.J00237
- Practice address
- 110 Kimball Dr
Lafayette, LA 70508-7802 - Phone
- (337) 344-7550
- NPI assigned
- May 25, 2018
- 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 | ATC.J00237 | LA | Primary |
Addresses
Primary practice location
110 Kimball Dr
Lafayette, LA 70508-7802
Mailing address
110 Kimball Dr
Lafayette, LA 70508-7802
Phone (337) 344-7550
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 |
|---|---|---|---|
| ATC.J00237 | LA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527206400000",
"number": "1891286753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 KIMBALL DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705087802",
"telephone_number": "337-344-7550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 KIMBALL DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705087802",
"telephone_number": "337-344-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "TERRY",
"middle_name": "R.",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-25",
"last_updated": "2018-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "LA",
"license": "ATC.J00237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.