Nicolette Julianne Carsillo, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT002863 Issued in GA

Practice address

3527 N Valdosta Rd
Valdosta, GA 31602-6418

Phone

(229) 247-2290

Fax

(229) 247-9627

NPI assigned

Jan 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484179200000",
    "number": "1104362359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3527 N VALDOSTA RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026418",
            "telephone_number": "229-247-2290",
            "fax_number": "229-247-9627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3527 N VALDOSTA RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026418",
            "telephone_number": "229-247-2290",
            "fax_number": "229-247-9627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARSILLO",
        "first_name": "NICOLETTE",
        "middle_name": "JULIANNE",
        "name_prefix": "Miss",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-12",
        "last_updated": "2017-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT002863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dewight Carruth
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• Arisje Brianna Carter, M.ED., CF-SLP
• Barbara Jane Carter, M.ED. CCC-SLP
• Brianna Carter
• Byron Lagary Carter, D.A., NP-C

• Athletic Trainer in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.