Active NPI
Mikayla Louise Moyer, LAT, ATC
- Athletic Trainer
- Forest City, IA
National Provider Identifier
1639638133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 097770
- Practice address
- 210 Bob Johnson Dr Apt 200
Forest City, IA 50436-2204 - Phone
- (319) 540-5904
- NPI assigned
- Mar 14, 2019
- Last updated
- Jan 14, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | IA | ||
| Athletic Trainer | 2255A2300X | 097770 | IA | Primary |
Addresses
Primary practice location
210 Bob Johnson Dr Apt 200
Forest City, IA 50436-2204
Mailing address
500 Fairfax Rd
Fairfax, IA 52228-9704
Phone (319) 540-5904
Other practice location 1
500 Fairfax Rd
Fairfax, IA 52228-9704
Phone (319) 540-5904
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mikayla.moyer@athletico.com |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 097770 | IA | MD | Athletic Trainer |
Interoperability endpoints
- mikayla.moyer@athletico.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1639638133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 FAIRFAX RD",
"city": "FAIRFAX",
"state": "IA",
"postal_code": "522289704",
"telephone_number": "319-540-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 BOB JOHNSON DR APT 200",
"city": "FOREST CITY",
"state": "IA",
"postal_code": "504362204",
"telephone_number": "319-540-5904"
}
],
"practiceLocations": [
{
"address_1": "500 Fairfax Rd",
"address_purpose": "LOCATION",
"city": "Fairfax",
"state": "IA",
"postal_code": "522289704",
"country_code": "US",
"telephone_number": "319-540-5904",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOYER",
"first_name": "MIKAYLA",
"middle_name": "LOUISE",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-14",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IA",
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IA",
"license": "097770",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mikayla.moyer@athletico.com",
"affiliation": "N",
"address_1": "461 S Illinois Ave",
"city": "Mason City",
"state": "IA",
"country_code": "US",
"postal_code": "504014439",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Forest City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.