Active NPI
Kenneth Shaw, ATC, LAT
- Athletic Trainer
- Bristol, TN
National Provider Identifier
1891417580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2994
- Practice address
- 1350 King College Rd
Bristol, TN 37620-2632 - Phone
- (800) 362-0014
- NPI assigned
- Sep 19, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 2994 | TN | Primary |
Addresses
Primary practice location
1350 King College Rd
Bristol, TN 37620-2632
Mailing address
362 Grandview St
Church Hill, TN 37642-3828
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 |
|---|---|---|---|
| 2994 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1891417580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "362 GRANDVIEW ST",
"city": "CHURCH HILL",
"state": "TN",
"postal_code": "376423828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 KING COLLEGE RD",
"city": "BRISTOL",
"state": "TN",
"postal_code": "376202632",
"telephone_number": "800-362-0014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "KENNETH",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bristol, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.