Active NPI
Kayla Lynn Fiveash, ATC
- Athletic Trainer
- Fayetteville, TN
National Provider Identifier
1508486630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36003559A
- Practice address
- 1816 Huntsville Hwy
Fayetteville, TN 37334-3787 - Phone
- (931) 228-5585
- NPI assigned
- Apr 18, 2020
- Last updated
- May 18, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2385 | TN | |
| Athletic Trainer | 2255A2300X | 36003559A | IN | Primary |
Addresses
Primary practice location
1816 Huntsville Hwy
Fayetteville, TN 37334-3787
Mailing address
1185 County Road 1000 W
Linton, IN 47441
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 |
|---|---|---|---|
| 2385 | TN | MD | Physical Therapy Assistant |
| 36003559A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684368000000",
"number": "1508486630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1185 COUNTY ROAD 1000 W",
"city": "LINTON",
"state": "IN",
"postal_code": "47441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1816 HUNTSVILLE HWY",
"city": "FAYETTEVILLE",
"state": "TN",
"postal_code": "373343787",
"telephone_number": "931-228-5585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIVEASH",
"first_name": "KAYLA",
"middle_name": "LYNN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-18",
"last_updated": "2023-05-18",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2385",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36003559A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, TN
- Fayetteville Medical Associates, PC
- Fayetteville Medical Clinic & Urgent Care
- Fayetteville MRI, LLC
- Fayetteville Operator LLC (Lincoln Manor)
- Fayetteville-Lincoln County Senior Citizens Center
- Windi Jean Fletcher, RDH
- Tiffany Forst, NP-C
- Shelania May Fowler, NP-C
- Amanda A Franks, PHARM D.
- Freds Stores of Tennessee Inc (Freds Pharmacy 1616)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.