Kayla Renee Eddy, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT007216 Issued in PA

Practice address

10529 S Rive Ridge Loop
Fort Drum, NY 13602

Phone

(315) 774-8155

NPI assigned

Dec 17, 2021

Last updated

Dec 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1225798275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N 3RD ST",
            "city": "HUGHESVILLE",
            "state": "PA",
            "postal_code": "177371904",
            "telephone_number": "570-419-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10529 S RIVE RIDGE LOOP",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-774-8155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Woodbine Ln",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "PA",
            "postal_code": "178218029",
            "country_code": "US",
            "telephone_number": "570-271-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDDY",
        "first_name": "KAYLA",
        "middle_name": "RENEE",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-17",
        "last_updated": "2022-12-01",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT007216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauri Ann Dunn, LCSW
• S. Folley Dunna, M.D.
• Elizabeth Duque, M.D.
• Katherine Paige Duty, OTR/L
• Roger Duane Eaks, LCSW
• William Edwards
• Jonathan Michael Ekas, OTR/L
• Carol Fabian, APRN, BC
• Mark W Fagan, DDS
• Margaret Fargo, DENTAL HYGIENIST

• Athletic Trainer in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.