Individual provider Active NPI

Caroline Jean Kandravi

  • Athletic Trainer
  • Green Bay, WI
National Provider Identifier
1770440133
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
331239 Issued in WI
Practice address
1970 S Ridge Rd
Green Bay, WI 54304-4125
Phone
(920) 430-4888
Fax
(920) 430-4889
NPI assigned
Jan 7, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 331239 WI Primary

Addresses

Primary practice location

1970 S Ridge Rd
Green Bay, WI 54304-4125

Mailing address

1570 Quarry Park Dr Apt 10
De Pere, WI 54115-7526
Phone (920) 471-7299

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

LicenseStateTypeSpecialty
331239WIMDAthletic Trainer

NPI Registry JSON

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

{
    "created_epoch": "1767744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767744000000",
    "number": "1770440133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 QUARRY PARK DR APT 10",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541157526",
            "telephone_number": "920-471-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 S RIDGE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543044125",
            "telephone_number": "920-430-4888",
            "fax_number": "920-430-4889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANDRAVI",
        "first_name": "CAROLINE",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-07",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "331239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2026; 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.