Active NPI
Ashley Kudla, ATC
- Athletic Trainer
- Algonquin, IL
National Provider Identifier
1033881156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.004178
- Practice address
- 650 S Randall Rd
Algonquin, IL 60102-5944 - Phone
- (779) 771-7000
- NPI assigned
- Sep 28, 2021
- Last updated
- Sep 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 096.004178 | IL | Primary |
Addresses
Primary practice location
650 S Randall Rd
Algonquin, IL 60102-5944
Mailing address
3424 Southport Dr
Island Lake, IL 60042-9123
Phone (847) 323-4603
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 |
|---|---|---|---|
| 096.004178 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632787200000",
"number": "1033881156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3424 SOUTHPORT DR",
"city": "ISLAND LAKE",
"state": "IL",
"postal_code": "600429123",
"telephone_number": "847-323-4603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 S RANDALL RD",
"city": "ALGONQUIN",
"state": "IL",
"postal_code": "601025944",
"telephone_number": "779-771-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUDLA",
"first_name": "ASHLEY",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-28",
"last_updated": "2021-09-28",
"certification_date": "2021-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.004178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Algonquin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.