Active NPI
Kaitlyn Maloney, MS. ED., ATC, LAT
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- De Soto, IL
National Provider Identifier
1750947586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 2000017799
- Practice address
- 125 Jan LN Apt 2
De Soto, IL 62924-0045 - Phone
- (302) 353-6468
- NPI assigned
- May 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 2000017799 | IL | Primary |
Addresses
Primary practice location
125 Jan LN Apt 2
De Soto, IL 62924-0045
Mailing address
125 Jan LN Apt 2
De Soto, IL 62924-0045
Phone (302) 353-6468
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 |
|---|---|---|---|
| 2000017799 | IL | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557964800000",
"number": "1750947586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 JAN LN APT 2",
"city": "DE SOTO",
"state": "IL",
"postal_code": "629240045",
"telephone_number": "302-353-6468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 JAN LN APT 2",
"city": "DE SOTO",
"state": "IL",
"postal_code": "629240045",
"telephone_number": "302-353-6468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALONEY",
"first_name": "KAITLYN",
"credential": "MS. ED., ATC, LAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-16",
"last_updated": "2019-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "IL",
"license": "2000017799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Soto, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.