Active NPI
Autumn Nicole Taylor
- Athletic Trainer
- Champaign, IL
National Provider Identifier
1346759586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 1750 S 4TH St
Champaign, IL 61820-6948 - Phone
- (443) 883-0156
- NPI assigned
- Sep 20, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
1750 S 4TH St
Champaign, IL 61820-6948
Mailing address
719 W Harvard St
Champaign, IL 61820-2804
Phone (443) 883-0156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 096.005126 | Other | IL | IDFPR- ATHLETIC TRAINER LICENSE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1346759586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "719 W HARVARD ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618202804",
"telephone_number": "443-883-0156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 S 4TH ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618206948",
"telephone_number": "443-883-0156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "AUTUMN",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-20",
"last_updated": "2020-10-30",
"certification_date": "2020-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDFPR- ATHLETIC TRAINER LICENSE",
"identifier": "096.005126",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.