Active NPI
Kennedie Ebersole
- Athletic Trainer
- Youngsville, PA
National Provider Identifier
1861983983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 248 E Main St
Youngsville, PA 16371-1174 - Phone
- (814) 706-9310
- NPI assigned
- May 24, 2018
- Last updated
- May 9, 2022
- Sex
- Female
- Sole proprietor
- No
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 | NU | ||
| Athletic Trainer | 2255A2300X | NU | Primary |
Addresses
Primary practice location
248 E Main St
Youngsville, PA 16371-1174
Mailing address
248 E Main St
Youngsville, PA 16371-1174
Phone (814) 706-9310
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652054400000",
"number": "1861983983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 E MAIN ST",
"city": "YOUNGSVILLE",
"state": "PA",
"postal_code": "163711174",
"telephone_number": "814-706-9310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 E MAIN ST",
"city": "YOUNGSVILLE",
"state": "PA",
"postal_code": "163711174",
"telephone_number": "814-706-9310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBERSOLE",
"first_name": "KENNEDIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-24",
"last_updated": "2022-05-09",
"certification_date": "2022-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngsville, PA
- Beth Anne Champlin, PT
- Children's Center for Treatment and Education (Beacon Light Behavioral Health System)
- Children's Center for Treatment and Education (Beacon Light Behavioral Health System)
- Clear Mind Health Services, LLC
- Darling Apothecary, LLC (The Youngsville Pharmacy)
- Jolene Renee Ferrie, OTR/L
- Kathleen M Lauger, OT
- Bernice C Markley, MA
- Elizabeth Kathryn McChesney, CCC-SLP
- Joseph J Pikna
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.