Kyle James Domin

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

605 Washington Street
Fayette, IA 52142

Phone

(630) 418-8352

NPI assigned

Sep 2, 2017

Sex

Male

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

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

{
    "created_epoch": "1504310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504310400000",
    "number": "1306364997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 WASHINGTON ST",
            "city": "FAYETTE",
            "state": "IA",
            "postal_code": "521429206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WASHINGTON STREET",
            "city": "FAYETTE",
            "state": "IA",
            "postal_code": "52142",
            "telephone_number": "630-418-8352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMIN",
        "first_name": "KYLE",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-02",
        "last_updated": "2017-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Boeke, MPA, LAT, ATC
• Cedar Sage PLLC
• Charming Smiles PC
• City of Fayette
• Colonial Manors of Fayette, Inc
• Jenna Marie Elsbernd
• Ryan Scott Fonkert, MS, ATC
• Joshua Ron Formanek, PHARMD
• Miranda Leann Franck, PMHNP-BC
• Gundersen Clinic, LTD.

• All providers in Fayette, IA
• Athletic Trainer in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2017; 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.