Kathleen M Mayberry, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.004177 Issued in IL

Practice address

515 Roanoke Dr
Edwardsville, IL 62025-2521

Phone

(618) 980-5605

NPI assigned

May 3, 2020

Last updated

May 3, 2020By 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

• Katie M Mayberry Other 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": "1588464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588464000000",
    "number": "1487275285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 ROANOKE DR",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252521",
            "telephone_number": "618-980-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 ROANOKE DR",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620252521",
            "telephone_number": "618-980-5605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-03",
        "last_updated": "2020-05-03",
        "certification_date": "2020-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.004177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "MAYBERRY",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Andrea Michelle Martin
• Maryville Imaging, LLC (Goshen Imaging)
• Thomas Richard Mason, PTA
• Kayla Mast, BEHAVIOR TECHNICIAN
• Sophia Elaine Rossi May
• Ashley Mayernik, DNP RN
• James Thomas Mays II, MS ED., ATC
• Lauren Elyse McBride, DNP PMHNP BC
• Yvonne M McCall, MA, LCPC
• Stacy M McCann, LCSW, BCBA, LBA

• Athletic Trainer in Edwardsville, IL
• Providers in Edwardsville, 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 3, 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.

Verify at the official NPI Registry.