Kendall Nicole Mikkelsen, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

19790 Ashburn Rd
Ashburn, VA 20147-5636

Phone

(571) 209-5500

NPI assigned

Feb 3, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• George Mason University

  • Orthopaedic Surgery Physician
  • Fairfax, VA
  • NPI 1114470606
  NPD (past)

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

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1992401640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11795 ANTIETAM RD",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221921214",
            "telephone_number": "210-422-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19790 ASHBURN RD",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475636",
            "telephone_number": "571-209-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4400 University Dr",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220304422",
            "country_code": "US",
            "telephone_number": "703-993-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIKKELSEN",
        "first_name": "KENDALL",
        "middle_name": "NICOLE",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-03",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Jane Merrion, PH.D.
• Mesi Health LLC
• India Shakita Messam
• Janae Messick
• Michael S Han DDS PC
• Ania Miller
• Brian Miller
• Kinsey Miller
• Mina Armanious, DDS, PLLC
• Siria Minaya, MA, NCC

• Athletic Trainer in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; 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.