Active NPI
McKenna Nicole Mardlin, MS, ATC, EMT, OPE-C
- Athletic Trainer
- Detroit, MI
National Provider Identifier
1295596013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601003117
- Practice address
- 4001 W McNichols Rd
Detroit, MI 48221-3038 - Phone
- (313) 623-2109
- NPI assigned
- Jan 18, 2024
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2601003117 | MI | Primary |
| Basic Emergency Medical Technician | 146N00000X | 2017040 | MI |
Addresses
Primary practice location
4001 W McNichols Rd
Detroit, MI 48221-3038
Mailing address
1161 Quail Ridge Dr
Oxford, MI 48371-6075
Phone (248) 807-1577
Other practice location 1
1161 Quail Ridge Dr
Oxford, MI 48371-6075
Phone (248) 807-1577
Other practice location 2
690 Amsterdam St
Detroit, MI 48202-3410
Phone (313) 623-2109
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
- Emergency Medical Technician, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017040 | MI | MD | Basic Emergency Medical Technician |
| 2601003117 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750291200000",
"number": "1295596013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1161 QUAIL RIDGE DR",
"city": "OXFORD",
"state": "MI",
"postal_code": "483716075",
"telephone_number": "248-807-1577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 W MCNICHOLS RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482213038",
"telephone_number": "313-623-2109"
}
],
"practiceLocations": [
{
"address_1": "1161 Quail Ridge Dr",
"address_purpose": "LOCATION",
"city": "Oxford",
"state": "MI",
"postal_code": "483716075",
"country_code": "US",
"telephone_number": "248-807-1577",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "690 Amsterdam St",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482023410",
"country_code": "US",
"telephone_number": "313-623-2109",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARDLIN",
"first_name": "MCKENNA",
"middle_name": "NICOLE",
"credential": "MS, ATC, EMT, OPE-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-18",
"last_updated": "2025-06-19",
"certification_date": "2025-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601003117",
"primary": true
},
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "MI",
"license": "2017040",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.