Individual provider Active NPI

Rachel Nicole Ellison, LMT, LAT, ATC

  • Athletic Trainer
  • Williamsburg, KY
National Provider Identifier
1558730945
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AT1744 Issued in KY
Practice address
6790 College Station Drive
Williamsburg, KY 40769
Phone
(606) 515-0390
NPI assigned
Sep 16, 2015
Last updated
May 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Athletic Trainer 2255A2300X
Athletic Trainer 2255A2300X AT1744 KY Primary
Massage Therapist 225700000X BMTMTH00222474 KY

Addresses

Primary practice location

6790 College Station Drive
Williamsburg, KY 40769

Mailing address

PO Box 483
Williamsburg, KY 40769-0483
Phone (606) 620-6901

Other practice location 1

410 Sycamore St
Williamsburg, KY 40769-1137
Phone (606) 549-4811

Other practice location 2

475 N Highway 25 W
Williamsburg, KY 40769-1576
Phone (606) 620-6901

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

LicenseStateTypeSpecialty
AT1744KYMDAthletic Trainer
BMTMTH00222474KYMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Health & Wellness, Inc. PastSince Jun 19, 2017 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1558730945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 483",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407690483",
            "telephone_number": "606-620-6901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6790 COLLEGE STATION DRIVE",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "40769",
            "telephone_number": "606-515-0390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "410 Sycamore St",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "KY",
            "postal_code": "407691137",
            "country_code": "US",
            "telephone_number": "606-549-4811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "475 N Highway 25 W",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "KY",
            "postal_code": "407691576",
            "country_code": "US",
            "telephone_number": "606-620-6901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "RACHEL",
        "middle_name": "NICOLE",
        "credential": "LMT, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-16",
        "last_updated": "2025-05-08",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KY",
            "license": "AT1744",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "KY",
            "license": "BMTMTH00222474",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; 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.