Active NPI
Kembra Lea Mathis, ATC
- Athletic Trainer
- Bentonville, AR
National Provider Identifier
1982676839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT 419
- Practice address
- 1801 SE J St
Bentonville, AR 72712-4295 - Phone
- (479) 254-5100
- NPI assigned
- Feb 5, 2006
- Last updated
- Sep 5, 2014
- 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 | AT 419 | AR | Primary |
Addresses
Primary practice location
1801 SE J St
Bentonville, AR 72712-4295
Mailing address
1601 Cresent St
Bentonville, AR 72712-9411
Phone (479) 877-9345
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 |
|---|---|---|---|
| AT 419 | AR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409875200000",
"number": "1982676839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 CRESENT ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727129411",
"telephone_number": "479-877-9345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 SE J ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727124295",
"telephone_number": "479-254-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "KEMBRA",
"middle_name": "LEA",
"name_prefix": "Mrs.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-05",
"last_updated": "2014-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "AT 419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bentonville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.