Jylissa Nicole Tahy, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

24-01071 Issued in KS

Practice address

1744 N Andover Rd
Andover, KS 67002-9472

Phone

(316) 218-4600

NPI assigned

Jul 3, 2023

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

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": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1558048249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 S WATSON LN",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672072266",
            "telephone_number": "970-570-7926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1744 N ANDOVER RD",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "670029472",
            "telephone_number": "316-218-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAHY",
        "first_name": "JYLISSA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KS",
            "license": "24-01071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Andover, KS
• Athletic Trainer in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.

Verify at the official NPI Registry.