Active NPI
Kelley Lacey, MAT, LAT, ATC
- Athletic Trainer
- Muncie, IN
National Provider Identifier
1952884405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 360002786A
- Practice address
- 2201 W University Ave
Muncie, IN 47306-2943 - Phone
- (765) 625-0244
- NPI assigned
- Sep 11, 2018
- 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 | 360002786A | IN | Primary |
Addresses
Primary practice location
2201 W University Ave
Muncie, IN 47306-2943
Mailing address
9301 W Windsor Rd
Farmland, IN 47340-9445
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 |
|---|---|---|---|
| 360002786A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1952884405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9301 W WINDSOR RD",
"city": "FARMLAND",
"state": "IN",
"postal_code": "473409445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 W UNIVERSITY AVE",
"city": "MUNCIE",
"state": "IN",
"postal_code": "473062943",
"telephone_number": "765-625-0244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACEY",
"first_name": "KELLEY",
"credential": "MAT, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-11",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "360002786A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muncie, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.