Tara Elizabeth Dudley, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.004516 Issued in IL

Practice address

3225 W Foster Ave
Chicago, IL 60625-4823

Phone

(313) 574-5257

Fax

(773) 634-4057

NPI assigned

Dec 17, 2017

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

State licenses

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

{
    "created_epoch": "1513468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513468800000",
    "number": "1619483419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5727 N WINTHROP AVE APT 104",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 W FOSTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254823",
            "telephone_number": "313-574-5257",
            "fax_number": "773-634-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "TARA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-17",
        "last_updated": "2017-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.004516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Dudley, RN
• Emily Dudley, AU.D.
• Hannah Dudley, OTR
• Lee Anthony Dudley, DO
• Shauntell Dudley, ED.S
• Megan Marie Dudney, PA-C
• Anastasiya Dudnyk
• Kathryn Liber Dudun, CPNP-PC
• Jacob Dudzinski, MD
• Richard J Due, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2017; 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.