Individual provider Active NPI

Kelby Rae Hurlocker, LAT, ATC

  • Athletic Trainer
  • Charlotte, NC
National Provider Identifier
1962017798
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
LAT-2991 Issued in NC
Practice address
500 Center Park Dr
Charlotte, NC 28217
Phone
(704) 791-5795
NPI assigned
Sep 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X LAT-2991 NC Primary

Addresses

Primary practice location

500 Center Park Dr
Charlotte, NC 28217

Mailing address

212 Brackenberry Cir
Mount Pleasant, NC 28124-9405
Phone (704) 791-5795

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

LicenseStateTypeSpecialty
LAT-2991NCMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1962017798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 BRACKENBERRY CIR",
            "city": "MOUNT PLEASANT",
            "state": "NC",
            "postal_code": "281249405",
            "telephone_number": "704-791-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CENTER PARK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28217",
            "telephone_number": "704-791-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HURLOCKER",
        "first_name": "KELBY",
        "middle_name": "RAE",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "LAT-2991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.