Michael Tyler Wilson, ATC, LAT

Athletic Trainer · Fayette, MO

Individual Active NPI

NPI number 1053864306

Practice location

411 Central Methodist Sq
Fayette, MO 65248-1104
Phone
(636) 577-5062

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NPI record

NPI
1053864306
Entity type
Individual (Type 1)
Enumeration date
August 3, 2016
Last updated
August 3, 2016
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Athletic Trainer Primary 2255A2300X 2016023484 MO

About Michael Wilson

Michael Tyler Wilson, ATC, LAT is a healthcare provider registered in the NPI registry with the primary taxonomy Athletic Trainer (code 2255A2300X). The practice location is 411 Central Methodist Sq, Fayette, MO 65248-1104. The NPI number 1053864306 was assigned on August 3, 2016 and the record was last updated on August 3, 2016.

Michael Wilson lists a license in the registry: #2016023484 (MO) for Athletic Trainer. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Michael Tyler Wilson, ATC, LAT?

The NPI number is 1053864306.

What is the phone number of Michael Wilson?

The phone number listed for the practice location is (636) 577-5062.

Where is Michael Wilson located?

411 Central Methodist Sq, Fayette, MO 65248-1104.

What is the taxonomy code for Michael Wilson?

The primary taxonomy code is 2255A2300X – Athletic Trainer.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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