Active NPI
Caitlin Keroack, ATC
- Athletic Trainer
- Normal, IL
National Provider Identifier
1841693652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096003548
- Practice address
- 110 Horton Fieldhouse
Campus Box 7130
Normal, IL 61790-7130 - Phone
- (309) 438-3340
- NPI assigned
- Oct 7, 2014
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096003548 | IL | Primary |
Addresses
Primary practice location
110 Horton Fieldhouse
Campus Box 7130
Normal, IL 61790-7130
Mailing address
3008 Camden Cir
Williamsburg, VA 23185-8713
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 |
|---|---|---|---|
| 096003548 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412640000000",
"number": "1841693652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3008 CAMDEN CIR",
"city": "WILLIAMSBURG",
"state": "VA",
"postal_code": "231858713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 HORTON FIELDHOUSE",
"address_2": "CAMPUS BOX 7130",
"city": "NORMAL",
"state": "IL",
"postal_code": "617907130",
"telephone_number": "309-438-3340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEROACK",
"first_name": "CAITLIN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-07",
"last_updated": "2014-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096003548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.