Active NPI
Tyesha Monique Kizer, MS, LAT, ATC
- Athletic Trainer
- Martin, TN
National Provider Identifier
1922766609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2887
- Practice address
- 15 Mount Pelia Rd
Martin, TN 38237-3313 - Phone
- (731) 881-7679
- NPI assigned
- Nov 30, 2021
- 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 | 2887 | TN | Primary |
Addresses
Primary practice location
15 Mount Pelia Rd
Martin, TN 38237-3313
Mailing address
154 Meadowbrook Dr
Martin, TN 38237-3704
Phone (540) 287-1790
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2887 | TN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638230400000",
"number": "1922766609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 MEADOWBROOK DR",
"city": "MARTIN",
"state": "TN",
"postal_code": "382373704",
"telephone_number": "540-287-1790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 MOUNT PELIA RD",
"city": "MARTIN",
"state": "TN",
"postal_code": "382373313",
"telephone_number": "731-881-7679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIZER",
"first_name": "TYESHA",
"middle_name": "MONIQUE",
"name_prefix": "Miss",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-30",
"last_updated": "2021-11-30",
"certification_date": "2021-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.