Kaitlin Sisson, CMT, NMT

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

90196 Issued in CA

Practice address

7765 Healdsburg Ave Ste 13C
Sebastopol, CA 95472-3355

Phone

(707) 206-8569

NPI assigned

Nov 8, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1104534130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 WARREN LN",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954015413",
            "telephone_number": "707-206-8569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7765 HEALDSBURG AVE STE 13C",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954723355",
            "telephone_number": "707-206-8569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSON",
        "first_name": "KAITLIN",
        "credential": "CMT, NMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "CA",
            "license": "90196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAMTC  CERTIFICATION",
            "identifier": "90196",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kaitlin.sisson@my.nhi.edu",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "business email address",
            "address_1": "7765 Healdsburg Ave Ste 13C",
            "city": "Sebastopol",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954723355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brittany Silva
• Harry S. Simms, MD
• Stacy Simons, CMT
• Jane Sipe, L. AC/
• Siskiyou Rural Housecalls Medical Corporation
• Julie Clare Smith, P.T.
• Phoebe L Smith, M.D.
• Teresa Smith
• Timothy J Smith, M.D.
• Max Cleatis Snell

• Public Health & General Preventive Medicine Physician in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Public Health & General Preventive Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.