Madissen Kailyn Davis, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096005381 Issued in IL

Practice address

2210 9TH St Apt 202
Charleston, IL 61920-4020

Phone

(682) 367-3823

NPI assigned

Jan 9, 2023

Sex

Female

Sole proprietor

No

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, last updated by the provider on Jan 9, 2023.

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1609580356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 9TH ST APT 202",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619204020",
            "telephone_number": "682-367-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 9TH ST APT 202",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619204020",
            "telephone_number": "682-367-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MADISSEN",
        "middle_name": "KAILYN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096005381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Crowley
• Brittany Nicole Crum
• CTF Illinois
• CTF Illinois
• Corey Marie Cunningham, MS LCPC
• Noah Mikael Davis, MS, LAT, ATC
• Melissa N Degiorgis, MSW
• Michael Parrish Dellinger, MHP
• Dental Professionals of Illinois, P.C.
• Michaela Elizabeth Desantis, ATC

• All providers in Charleston, IL
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.