Active NPI
Tiffany Louise Green, ATC
- Athletic Trainer
- Charleston, IL
National Provider Identifier
1558635219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 1501 Woodlawn Dr
Apt. #1
Charleston, IL 61920-4262 - Phone
- (906) 290-2429
- NPI assigned
- Feb 28, 2012
- Last updated
- Feb 28, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | IL | Primary |
Addresses
Primary practice location
1501 Woodlawn Dr
Apt. #1
Charleston, IL 61920-4262
Mailing address
1501 Woodlawn Dr
Apt. #1
Charleston, IL 61920-4262
Phone (906) 290-2429
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330387200000",
"number": "1558635219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 WOODLAWN DR",
"address_2": "APT. #1",
"city": "CHARLESTON",
"state": "IL",
"postal_code": "619204262",
"telephone_number": "906-290-2429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 WOODLAWN DR",
"address_2": "APT. #1",
"city": "CHARLESTON",
"state": "IL",
"postal_code": "619204262",
"telephone_number": "906-290-2429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "TIFFANY",
"middle_name": "LOUISE",
"name_prefix": "Mrs.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-28",
"last_updated": "2012-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.