Kaitlin Carlson
Individual provider Active NPI Athletic Trainer · Peoria, IL
NPI 1104274851 · NPPES record last updated Dec 31, 2019
Key facts
- NPI
- 1104274851
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 6000 N Allen Rd
Peoria, IL 61614-3294 - Phone
- (309) 691-1400
- Fax
- (309) 693-3197
- NPI assigned
- Jun 2, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
6000 N Allen Rd
Peoria, IL 61614-3294
Mailing address
6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400
Other practice location 1
1501 W Bradley Ave
Peoria, IL 61625-0001
Phone (309) 677-2688
Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.