Active NPI
Ebony Taryn Rose, MS, LAT, ATC
- Athletic Trainer
- Fort Polk, LA
National Provider Identifier
1710441951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT8123
- Practice address
- 1585 3Rd St
Fort Polk, LA 71459-5102 - Phone
- (337) 531-3011
- NPI assigned
- Jan 22, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT8123 | TX | Primary |
| Athletic Trainer | 2255A2300X | AT005900 | OH |
Addresses
Primary practice location
1585 3Rd St
Fort Polk, LA 71459-5102
Mailing address
124 Hinge Chase
Cibolo, TX 78108-3375
Other practice location 1
340 Mississippi St SE
North Canton, OH 44720-3608
Phone (210) 623-0303
Other practice location 2
124 Hinge Chase
Cibolo, TX 78108-3375
Phone (210) 623-0303
Other practice location 3
80 Bowers Blvd
Huntsville, TX 77341-0001
Phone (936) 294-1111
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT005900 | OH | MD | Athletic Trainer |
| AT8123 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665446400000",
"number": "1710441951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 HINGE CHASE",
"city": "CIBOLO",
"state": "TX",
"postal_code": "781083375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1585 3RD ST",
"city": "FORT POLK",
"state": "LA",
"postal_code": "714595102",
"telephone_number": "337-531-3011"
}
],
"practiceLocations": [
{
"address_1": "340 Mississippi St SE",
"address_purpose": "LOCATION",
"city": "North Canton",
"state": "OH",
"postal_code": "447203608",
"country_code": "US",
"telephone_number": "210-623-0303",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "124 Hinge Chase",
"address_purpose": "LOCATION",
"city": "Cibolo",
"state": "TX",
"postal_code": "781083375",
"country_code": "US",
"telephone_number": "210-623-0303",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "80 Bowers Blvd",
"address_purpose": "LOCATION",
"city": "Huntsville",
"state": "TX",
"postal_code": "773410001",
"country_code": "US",
"telephone_number": "936-294-1111",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROSE",
"first_name": "EBONY",
"middle_name": "TARYN",
"name_prefix": "Ms.",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-22",
"last_updated": "2022-10-11",
"certification_date": "2022-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT8123",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT005900",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Polk, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.