Active NPI
Laraleigh Roberts, ATC
- Athletic Trainer
- Lauderdale, MS
National Provider Identifier
1174233449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2879
- Practice address
- 4182 Wild Duck Dr
Lauderdale, MS 39335-9515 - Phone
- (601) 604-9983
- NPI assigned
- Nov 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | 2879 | AL | Primary |
Addresses
Primary practice location
4182 Wild Duck Dr
Lauderdale, MS 39335-9515
Mailing address
4182 Wild Duck Dr
Lauderdale, MS 39335-9515
Phone (601) 604-9983
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 |
|---|---|---|---|
| 2879 | AL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1174233449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4182 WILD DUCK DR",
"city": "LAUDERDALE",
"state": "MS",
"postal_code": "393359515",
"telephone_number": "601-604-9983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4182 WILD DUCK DR",
"city": "LAUDERDALE",
"state": "MS",
"postal_code": "393359515",
"telephone_number": "601-604-9983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "LARALEIGH",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-28",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "2879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lauderdale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.