Active NPI
Kelley M Davis, BSAT, ATC
- Athletic Trainer
- Ellwood City, PA
National Provider Identifier
1104961069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT003474
- Practice address
- 1677 Route 65
Ellwood City, PA 16117-5217 - Phone
- (724) 752-2716
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 | RT003474 | PA | Primary |
Addresses
Primary practice location
1677 Route 65
Ellwood City, PA 16117-5217
Mailing address
3322 3Rd Ave
P.O. Box 417
Koppel, PA 16136
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 |
|---|---|---|---|
| RT003474 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104961069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3322 3RD AVE",
"address_2": "P.O. BOX 417",
"city": "KOPPEL",
"state": "PA",
"postal_code": "16136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1677 ROUTE 65",
"city": "ELLWOOD CITY",
"state": "PA",
"postal_code": "161175217",
"telephone_number": "724-752-2716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KELLEY",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "BSAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT003474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellwood City, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.