Taylor Jeanette Rosecrans, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.004375 Issued in IL

Practice address

468 N Ken Gray Pkwy
Ina, IL 62846-2408

Phone

(618) 437-5321

NPI assigned

Nov 11, 2016

Last updated

Dec 23, 2021By 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

Other names 1

• Taylor Jeanette Simmons Former name

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": "1478822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1366984015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "468 N KEN GRAY PKWY",
            "city": "INA",
            "state": "IL",
            "postal_code": "628462408",
            "telephone_number": "618-437-5321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "468 N KEN GRAY PKWY",
            "city": "INA",
            "state": "IL",
            "postal_code": "628462408",
            "telephone_number": "618-437-5321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSECRANS",
        "first_name": "TAYLOR",
        "middle_name": "JEANETTE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-11",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.004375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "SIMMONS",
            "middle_name": "JEANETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gary Gerst, PA-C
• Ina Comm Cons School Dist 8
• John Randall Shepherd, M.D.

• Athletic Trainer in Ina, IL
• Providers in Ina, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; 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.