Active NPI
Raegan Willis, ATC
- Athletic Trainer
- Thibodaux, LA
National Provider Identifier
1427886415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 334488
- Practice address
- 906 E 1St St
Thibodaux, LA 70301-6701 - Phone
- (985) 448-4507
- NPI assigned
- Jul 23, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 334488 | LA | Primary |
Addresses
Primary practice location
906 E 1St St
Thibodaux, LA 70301-6701
Mailing address
16923 Evergreen Hills Ave
Greenwell Springs, LA 70739-3920
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 334488 | LA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1427886415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16923 EVERGREEN HILLS AVE",
"city": "GREENWELL SPRINGS",
"state": "LA",
"postal_code": "707393920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "906 E 1ST ST",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703016701",
"telephone_number": "985-448-4507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "RAEGAN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-23",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "LA",
"license": "334488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thibodaux, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.