Active NPI
Kerry Wimberly, ATC, LAT
- Athletic Trainer
- Lubbock, TX
National Provider Identifier
1902992738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT1390
- Practice address
- 4601 S. Loop 289 #11
Lubbock, TX 79424 - Phone
- (806) 792-7200
- Fax
- (806) 792-7225
- NPI assigned
- Oct 5, 2006
- 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 | AT1390 | TX | Primary |
Addresses
Primary practice location
4601 S. Loop 289 #11
Lubbock, TX 79424
Mailing address
4601 S. Loop 289 #11
Lubbock, TX 79424
Phone (806) 792-7200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AT1390 | Other | TX | LICENSED ATHLETIC TRAINER |
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 |
|---|---|---|---|
| AT1390 | TX | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CSK Medical Partners | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902992738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 S. LOOP 289 #11",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79424",
"telephone_number": "806-792-7200",
"fax_number": "806-792-7225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 S. LOOP 289 #11",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79424",
"telephone_number": "806-792-7200",
"fax_number": "806-792-7225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIMBERLY",
"first_name": "KERRY",
"name_prefix": "Mr.",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT1390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED ATHLETIC TRAINER",
"identifier": "AT1390",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
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.