Active NPI
Caroline Rose Pettijohn, ATC
- Athletic Trainer
- Kansas City, MO
National Provider Identifier
1134536683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1769
- Practice address
- 8600 N Hickory St
Apt 512
Kansas City, MO 64155-4103 - Phone
- (314) 608-1112
- NPI assigned
- Jul 16, 2014
- 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 | 1769 | TN | Primary |
Addresses
Primary practice location
8600 N Hickory St
Apt 512
Kansas City, MO 64155-4103
Mailing address
8600 N Hickory St
Apt 512
Kansas City, MO 64155-4103
Phone (314) 608-1112
Other names 1
- Caroline Rose Williams
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 |
|---|---|---|---|
| 1769 | TN | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1134536683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8600 N HICKORY ST",
"address_2": "APT 512",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641554103",
"telephone_number": "314-608-1112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8600 N HICKORY ST",
"address_2": "APT 512",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641554103",
"telephone_number": "314-608-1112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIJOHN",
"first_name": "CAROLINE",
"middle_name": "ROSE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-16",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "1769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CAROLINE",
"last_name": "WILLIAMS",
"middle_name": "ROSE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.