Active NPI
Alyssa Brooke Rotenberry, ATC
- Athletic Trainer
- Natchitoches, LA
National Provider Identifier
1225557986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 125557986
- Practice address
- 220 Jefferson St
Natchitoches, LA 71457 - Phone
- (318) 357-4273
- NPI assigned
- Sep 13, 2017
- Last updated
- Jul 31, 2018
- 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 | 125557986 | LA | Primary |
Addresses
Primary practice location
220 Jefferson St
Natchitoches, LA 71457
Mailing address
613 Marion St
Natchitoches, LA 71457-5519
Other practice location 1
1100 14th Ave Apt A3
Tuscaloosa, AL 35401
Phone (205) 617-5313
Other practice location 2
323 Bryant Drive
Tuscaloosa, AL 35487-0001
Phone (205) 617-5313
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | AL | BCBS |
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 |
|---|---|---|---|
| 125557986 | LA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532995200000",
"number": "1225557986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 MARION ST",
"city": "NATCHITOCHES",
"state": "LA",
"postal_code": "714575519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 JEFFERSON ST",
"city": "NATCHITOCHES",
"state": "LA",
"postal_code": "71457",
"telephone_number": "318-357-4273"
}
],
"practiceLocations": [
{
"address_1": "1100 14th Ave Apt A3",
"address_purpose": "LOCATION",
"city": "Tuscaloosa",
"state": "AL",
"postal_code": "35401",
"country_code": "US",
"telephone_number": "205-617-5313",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "323 Bryant Drive",
"address_purpose": "LOCATION",
"city": "Tuscaloosa",
"state": "AL",
"postal_code": "354870001",
"country_code": "US",
"telephone_number": "205-617-5313",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROTENBERRY",
"first_name": "ALYSSA",
"middle_name": "BROOKE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-13",
"last_updated": "2018-07-31",
"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": "LA",
"license": "125557986",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "NA",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Natchitoches, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.