Gianisa Nicole Dougherty, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

650 Lem Morrison Drive
Aubrun, AL 36830

Phone

(224) 523-0191

NPI assigned

Aug 31, 2021

Last updated

Aug 31, 2021By the provider in NPPES

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

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1609544147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10012 THORNTON WAY APT SUITE",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601422390",
            "telephone_number": "224-523-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 LEM MORRISON DRIVE",
            "city": "AUBRUN",
            "state": "AL",
            "postal_code": "36830",
            "telephone_number": "224-523-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "GIANISA",
        "middle_name": "NICOLE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-08-31",
        "certification_date": "2021-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.