Active NPI
Jordan Kay Lyles, LAT, ATC
- Athletic Trainer
- Waco, TX
National Provider Identifier
1295292415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT7989
- Practice address
- 15 Dahlia St
Waco, TX 76708-9633 - Phone
- (916) 295-8281
- NPI assigned
- Feb 24, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT7989 | TX | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
15 Dahlia St
Waco, TX 76708-9633
Mailing address
15 Dahlia St
Waco, TX 76708-9633
Phone (916) 295-8281
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 |
|---|---|---|---|
| AT7989 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727136000000",
"number": "1295292415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 DAHLIA ST",
"city": "WACO",
"state": "TX",
"postal_code": "767089633",
"telephone_number": "916-295-8281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 DAHLIA ST",
"city": "WACO",
"state": "TX",
"postal_code": "767089633",
"telephone_number": "916-295-8281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYLES",
"first_name": "JORDAN",
"middle_name": "KAY",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-24",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT7989",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.