Kayla Tisdale, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000051398 Issued in FL

Practice address

30330 Quinn Rd
Tomball, TX 77375-4300

Phone

(281) 357-3220

NPI assigned

Jan 4, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1396458436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1928 JOHANNA DR APT 202",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770551960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30330 QUINN RD",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "773754300",
            "telephone_number": "281-357-3220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1928 Johanna Dr Apt 202",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770551960",
            "country_code": "US",
            "telephone_number": "615-335-5961",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "KAYLA",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-04",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "2000051398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "AT9121",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOC CERTIFICATION",
            "identifier": "2000051398",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ktisdale@houstonmethodist.org",
            "affiliation": "Y",
            "affiliationName": "Houston Methodist Willowbrook Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "18220",
            "address_2": "TX 249",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "77055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Tomball, TX
• Providers in Tomball, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.