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1497122881 NPI number — KYLE ANDRE ST. PETER LAT, ATC

NPI Number: 1497122881
Health Care Provider/Practitioner: KYLE ANDRE ST. PETER LAT, ATC

Information about “1497122881” NPI (KYLE ANDRE ST. PETER LAT, ATC) exists in 1497122881 in HTML format HTML  |  1497122881 in plain Text format TXT  |  1497122881 in PDF (Portable Document Format) PDF  |  1497122881 in an XML format XML  formats.

NPI Number : 1497122881 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497122881",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ST. PETER",
    "FirstName": "KYLE",
    "MiddleName": "ANDRE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11318 WESTBROOK MILL LN UNIT 103",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIRFAX",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22030-5665",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4400 UNIVERSITY DR, MS 3A5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRFAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22030",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-993-3280",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/01/2015",
    "LastUpdateDate": "12/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2601001718",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "146N00000X",
          "TaxonomyName": "Basic Emergency Medical Technician",
          "LicenseNumber": "3203056420",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "0126003666",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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