Calista Marie Fasano, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT9143 Issued in TX

Practice address

620 Bowers Blvd
Huntsville, TX 77341-0001

Phone

(936) 294-3532

NPI assigned

Sep 15, 2022

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

Electronic endpoints 1

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": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1750003851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 SYCAMORE AVE APT D7",
            "city": "HUNTSVILLE",
            "state": "TX",
            "postal_code": "773406145",
            "telephone_number": "425-890-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 BOWERS BLVD",
            "city": "HUNTSVILLE",
            "state": "TX",
            "postal_code": "773410001",
            "telephone_number": "936-294-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASANO",
        "first_name": "CALISTA",
        "middle_name": "MARIE",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT9143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cxf064@shsu.edu",
            "affiliation": "N",
            "address_1": "620 Bowers Blvd",
            "city": "Huntsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773410001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Huntsville, TX
• Providers in Huntsville, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.

Verify at the official NPI Registry.