Lisa Ann Tate, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36000648A Issued in IN

Practice address

2312 S Dixon Rd
Suite 250
Kokomo, IN 46902-6401

Phone

(765) 455-2122

Fax

(765) 455-3122

NPI assigned

Aug 15, 2012

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

• Ms. Lisa Ann Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344988800000",
    "number": "1871841338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 S DIXON RD",
            "address_2": "SUITE 250",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026401",
            "telephone_number": "765-455-2122",
            "fax_number": "765-455-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 S DIXON RD",
            "address_2": "SUITE 250",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026401",
            "telephone_number": "765-455-2122",
            "fax_number": "765-455-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-15",
        "last_updated": "2012-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36000648A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "JACKSON",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heidi Renee Tanner, RPH
• Elena Christine Tansy, FNP
• Mohammad Tariq, MD
• Brian Paul Tate, DDS, MSD
• Jasmine Tate
• Meranda Tate
• Rodney Brandyn Tate
• Rita Marie Tattersall, L.C.A.C.
• Taylor Community School Corporation
• Taylor Township of Howard County

• Athletic Trainer in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; 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.