Katy Renee Gayford, ATC, PHD

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096001698 Issued in IL

Practice address

701 College Rd
Lebanon, IL 62254-1291

Phone

(618) 537-6472

NPI assigned

Jun 18, 2020

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

Other names 1

• Katy Renee Taake Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1588280200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 COLLEGE RD",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541291",
            "telephone_number": "618-537-6472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COLLEGE RD",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541291",
            "telephone_number": "618-537-6472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYFORD",
        "first_name": "KATY",
        "middle_name": "RENEE",
        "credential": "ATC, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096001698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATY",
            "last_name": "TAAKE",
            "middle_name": "RENEE",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sydney Diekhoff, ATC
• Evercare of Lebanon LLC
• Dale A Fischer, DC
• Jacob Eldon Frazier, DMD, MS
• Tonya Gass
• Kelsey Gerdes
• Meagan Elise Graul, DMD
• Justin Groennert, O.D.
• Jill Lynn Groom
• Dawn M. Hankins, PHD, ATC

• Athletic Trainer in Lebanon, IL
• Providers in Lebanon, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.