Active NPI
Kaitlin Inniss
- Athletic Trainer
- Phoenix, AZ
National Provider Identifier
1831749852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATR-009302
- Practice address
- 17017 N 12TH St Unit 1003
Phoenix, AZ 85022-2031 - Phone
- (307) 421-6389
- NPI assigned
- Sep 12, 2019
- Reactivated
- Oct 14, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | AZ | ||
| Athletic Trainer | 2255A2300X | ATR-009302 | AZ | Primary |
Addresses
Primary practice location
17017 N 12TH St Unit 1003
Phoenix, AZ 85022-2031
Mailing address
2811 Foothills Rd
Cheyenne, WY 82009-4536
Phone (307) 421-6389
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 |
|---|---|---|---|
| ATR-009302 | AZ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648252800000",
"number": "1831749852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2811 FOOTHILLS RD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820094536",
"telephone_number": "307-421-6389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17017 N 12TH ST UNIT 1003",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850222031",
"telephone_number": "307-421-6389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INNISS",
"first_name": "KAITLIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-12",
"last_updated": "2022-03-26",
"certification_date": "2022-03-26",
"deactivation_date": "2021-08-18",
"reactivation_date": "2021-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "AZ",
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "ATR-009302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
- Thomas Edward Inman Jr., D.O.
- Inmotion Health & Wellness, LLC
- Mahy Innabi
- Innervision Az, Inc
- Jennifer Innes, DPT
- Innovative Health Partners LLC
- Innovative Home Health Care Inc
- Innovative Inpatient Services, PC
- Innovative Minds Behavioral Health Services
- Innovative Neuropathy Treatment Institute, PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.