Active NPI
Nicole Phegley, MS, LAT, OTC
- Athletic Trainer
- Madison, WI
National Provider Identifier
1750779310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1619
- Practice address
- 621 Science Dr
Madison, WI 53711-1074 - Phone
- (908) 752-0592
- NPI assigned
- Jan 6, 2015
- 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | 14-1116 | WI | |
| Athletic Trainer | 2255A2300X | 1619 | WI | Primary |
Addresses
Primary practice location
621 Science Dr
Madison, WI 53711-1074
Mailing address
621 Science Dr
Madison, WI 53711-1074
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 |
|---|---|---|---|
| 14-1116 | WI | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424131200000",
"number": "1750779310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "621 SCIENCE DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537111074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 SCIENCE DR",
"city": "MADISON",
"state": "WI",
"postal_code": "537111074",
"telephone_number": "908-752-0592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHEGLEY",
"first_name": "NICOLE",
"credential": "MS, LAT, OTC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-06",
"last_updated": "2015-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "WI",
"license": "14-1116",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.