Healthcare Provider Details

I. General information

NPI: 1366971301
Provider Name (Legal Business Name): TYLER TIMOTHY TRIGGS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11231 N MADISON AVE
KANSAS CITY MO
64155-1085
US

IV. Provider business mailing address

11231 N MADISON AVE
KANSAS CITY MO
64155-1085
US

V. Phone/Fax

Practice location:
  • Phone: 417-689-0553
  • Fax:
Mailing address:
  • Phone: 417-689-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT10609
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2037
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-10273463
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126004525
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2017022236
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01277
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: