Megumi Ikeda Mitchell, MS, ATC/LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1339 Issued in AL

Practice address

21630 State Highway 59 S
Robertsdale, AL 36567-6710

Phone

(251) 947-4154

Fax

(251) 947-2666

NPI assigned

Jun 23, 2021

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

Other names 1

• Megumi Ikeda Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1760051783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14658 SILVER OAKS LOOP",
            "city": "SILVERHILL",
            "state": "AL",
            "postal_code": "365763741",
            "telephone_number": "251-600-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21630 STATE HIGHWAY 59 S",
            "city": "ROBERTSDALE",
            "state": "AL",
            "postal_code": "365676710",
            "telephone_number": "251-947-4154",
            "fax_number": "251-947-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MEGUMI",
        "middle_name": "IKEDA",
        "credential": "MS, ATC/LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AL",
            "license": "1339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEGUMI",
            "last_name": "IKEDA",
            "credential": "MS, ATC/LAT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexa Sheridan Lipe, DPT
• Shamara Martin
• Ruth Ann McCarty
• Morgan Kennedy McEvoy, D.M.D.
• Kirk Aaron Mears, PHARMD
• Caroline Grace Molyneux, FNP-C
• Chris Montz, ABOC
• Charlie Neal Morris, MSW
• Judy Murphy, LPC
• Sarah Elizabeth Nielsen, DDS

• Athletic Trainer in Robertsdale, AL
• Providers in Robertsdale, AL by specialty
• Athletic Trainer in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.