Active NPI
Kayla Macinnis, MS, ATC, EMT-B
- Athletic Trainer
- Danbury, CT
National Provider Identifier
1164815809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1084
- Practice address
- 73 Southern Blvd
Danbury, CT 06810 - Phone
- (203) 744-1510
- NPI assigned
- Mar 5, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | 22885 | CT | |
| Athletic Trainer | 2255A2300X | 1084 | CT | Primary |
Addresses
Primary practice location
73 Southern Blvd
Danbury, CT 06810
Mailing address
73 Southern Blvd
Danbury, CT 06810-7994
Phone (203) 744-1510
Other practice location 1
43 Lake Avenue Ext.
Danbury, CT 06811
Phone (203) 837-9063
Other practice location 2
116 Danbury Rd Ste 5
New Milford, CT 06776-3442
Phone (960) 354-7605
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22885 | Other | CT | EMT-B |
| 2000018481 | Other | CT | NATIONAL ATHLETIC TRAINERS ASSOCIATION - BOARD OF CERTIFICATION |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1084 | CT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550966400000",
"number": "1164815809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "73 SOUTHERN BLVD",
"city": "DANBURY",
"state": "CT",
"postal_code": "068107994",
"telephone_number": "203-744-1510",
"fax_number": "203-744-1275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "73 SOUTHERN BLVD",
"city": "DANBURY",
"state": "CT",
"postal_code": "06810",
"telephone_number": "203-744-1510"
}
],
"practiceLocations": [
{
"address_1": "43 Lake Avenue Ext.",
"address_purpose": "LOCATION",
"city": "Danbury",
"state": "CT",
"postal_code": "06811",
"country_code": "US",
"telephone_number": "203-837-9063",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "116 Danbury Rd Ste 5",
"address_purpose": "LOCATION",
"city": "New Milford",
"state": "CT",
"postal_code": "067763442",
"country_code": "US",
"telephone_number": "960-354-7605",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MACINNIS",
"first_name": "KAYLA",
"credential": "MS, ATC, EMT-B",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-05",
"last_updated": "2019-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "CT",
"license": "22885",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CT",
"license": "1084",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMT-B",
"identifier": "22885",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL ATHLETIC TRAINERS ASSOCIATION - BOARD OF CERTIFICATION",
"identifier": "2000018481",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.