Tait Carlisle, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT0923 Issued in MS

Practice address

118 College Dr
Hattiesburg, MS 39406-0001

Phone

(601) 266-5104

NPI assigned

Sep 7, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598745600000",
    "number": "1508384835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 SOUTHERN HILLS DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394015829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 COLLEGE DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394060001",
            "telephone_number": "601-266-5104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "718 Magnolia Drive",
            "address_purpose": "LOCATION",
            "city": "Tuscaloosa",
            "state": "AL",
            "postal_code": "354870001",
            "country_code": "US",
            "telephone_number": "205-915-5257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "TAIT",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-07",
        "last_updated": "2020-08-30",
        "certification_date": "2020-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MS",
            "license": "AT0923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carewell Personal Care Services, LLC
• Thomas Edwards Carey, M.D.
• Caring Touch Homecare Services
• Margaret Frances Carlin, PH.D.
• Adrienne Deanette Carlisle, LPC
• Avery Carpenter, FNP-BC
• Jordan Leigh Carpenter, PT
• Rechendia Carpenter, FNP
• Vicki Renee Carpenter, DNP
• Deborah Carr

• Athletic Trainer in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Athletic Trainer in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.