Noah Mikael Davis, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

600 Lincoln Ave
Charleston, IL 61920-3099

Phone

(618) 554-8410

NPI assigned

May 8, 2025

Last updated

May 8, 2025By the provider in NPPES

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

Credentials

Master of Science

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

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1407646805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 10TH ST APT 102",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203436",
            "telephone_number": "618-554-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 LINCOLN AVE",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203099",
            "telephone_number": "618-554-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "NOAH",
        "middle_name": "MIKAEL",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Nicole Crum
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• Michael Parrish Dellinger, MHP
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• Michaela Elizabeth Desantis, ATC
• Developmental Foundations, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.

Verify at the official NPI Registry.