Active NPI
Kylie Elizabeth Martindale, ATC
- Prevention Professional
- Anderson, IN
National Provider Identifier
1710547492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 36003006A
- Practice address
- 2610 Enterprise Dr
Anderson, IN 46013-9684 - Phone
- (800) 622-6575
- NPI assigned
- Jun 16, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 36003006A | IN | Primary |
Addresses
Primary practice location
2610 Enterprise Dr
Anderson, IN 46013-9684
Mailing address
1122 Waggoner Dr
Rushville, IN 46173-1060
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 |
|---|---|---|---|
| 36003006A | IN | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560643200000",
"number": "1710547492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 WAGGONER DR",
"city": "RUSHVILLE",
"state": "IN",
"postal_code": "461731060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2610 ENTERPRISE DR",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460139684",
"telephone_number": "800-622-6575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINDALE",
"first_name": "KYLIE",
"middle_name": "ELIZABETH",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-16",
"last_updated": "2019-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "IN",
"license": "36003006A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anderson, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.