Active NPI
Kimberly R Penkert, ATC
- Athletic Trainer
- New Prague, MN
National Provider Identifier
1922022326
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 060402447
- Practice address
- 301 2ND St NE
New Prague, MN 56071-1709 - Phone
- (952) 758-8161
- Fax
- (952) 758-1938
- NPI assigned
- Jul 27, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 060402447 | MN | Primary |
Addresses
Primary practice location
301 2ND St NE
New Prague, MN 56071-1709
Mailing address
221 Inverness Drive
Mankato, MN 56001
Phone (507) 276-3839
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 |
|---|---|---|---|
| 060402447 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373500800000",
"number": "1922022326",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 INVERNESS DRIVE",
"city": "MANKATO",
"state": "MN",
"postal_code": "56001",
"telephone_number": "507-276-3839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 2ND ST NE",
"city": "NEW PRAGUE",
"state": "MN",
"postal_code": "560711709",
"telephone_number": "952-758-8161",
"fax_number": "952-758-1938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENKERT",
"first_name": "KIMBERLY",
"middle_name": "R",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-27",
"last_updated": "2013-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "060402447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Prague, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.