Active NPI
Alissa Niswonger, MS, LAT, ATC
- Athletic Trainer
- Fort Wayne, IN
National Provider Identifier
1922547215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 005105
- Practice address
- 3946 Ice Way
Fort Wayne, IN 46805-1018 - Phone
- (219) 861-9144
- NPI assigned
- Feb 20, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 005105 | OH | Primary |
Addresses
Primary practice location
3946 Ice Way
Fort Wayne, IN 46805-1018
Mailing address
1000 W Fountain Grove Dr
Bryan, OH 43506
Phone (419) 636-4536
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005105 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733270400000",
"number": "1922547215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 W FOUNTAIN GROVE DR",
"city": "BRYAN",
"state": "OH",
"postal_code": "43506",
"telephone_number": "419-636-4536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3946 ICE WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468051018",
"telephone_number": "219-861-9144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISWONGER",
"first_name": "ALISSA",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-20",
"last_updated": "2024-12-04",
"certification_date": "2024-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "005105",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.