Krisha Kackley

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

24-01240 Issued in KS

Practice address

10790 Nall Ave
Overland Park, KS 66211-1206

Phone

(316) 300-1047

NPI assigned

Sep 21, 2018

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

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": "1537488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537488000000",
    "number": "1497239834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10242 W 80TH ST APT 213",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662044706",
            "telephone_number": "316-300-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10790 NALL AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111206",
            "telephone_number": "316-300-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACKLEY",
        "first_name": "KRISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-21",
        "last_updated": "2018-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KS",
            "license": "24-01240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Athletic Trainer in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; 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.