STACY ELLEN LAKE ATC
NPI 1912274663
Specialist/Technologist - Athletic Trainer in Fort Wayne, IN

Q: What is Stacy Lake's NPI number?

The NPI number for Stacy Lake is 1912274663. It was assigned to this individual provider in the NPPES registry on November 23, 2011.

Q: What is Stacy Lake's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, specializing in Athletic Trainer, with taxonomy code 2255A2300X.

Q: When was this NPI record last updated?

The NPPES record for Stacy Lake was last updated on November 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 23, 2011

14730 PULVER RD, FORT WAYNE, IN 46845(260) 413-6770 Get Directions Write a Review

NPPES record last updated: November 23, 2011. Verified against the NPPES registry weekly; last sync: August 30, 2026.

On this page

About Stacy Ellen Lake Atc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACY ELLEN LAKE ATC (NPI 1912274663) is an individual athletic trainer provider in Fort Wayne, Indiana, licensed in Indiana (36000573A) and active in the NPI registry since November 2011.

NPPES Registry Identity

NPI1912274663

Entity TypeIndividualFemale

Primary Taxonomy2255A2300X

Provider Legal NameSTACY ELLEN LAKECredential: ATC

Location Address14730 PULVER RDFort Wayne, IN 46845-9629

Mailing Address14730 Pulver RdFort Wayne, IN 46845 · (260) 413-6770

Phone(260) 413-6770

Sole ProprietorNo

Enumeration DateNovember 23, 2011

✔ NPI 1912274663 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialist/Technologist · Athletic TrainerRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code2255A2300X

License✔ Licensed in IN · 36000573A

Definition

Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor's degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration.

14730 PULVER RD, Fort Wayne, IN 46845

Open in Google Maps ↗

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacy Lake's NPI number?

The NPI number for Stacy Lake is 1912274663. It was assigned to this individual provider in the NPPES registry on November 23, 2011.

Where is Stacy Lake located?

Stacy Lake practices at 14730 Pulver Rd, Fort Wayne, IN 46845. The listed phone number is (260) 413-6770.

What is Stacy Lake's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, specializing in Athletic Trainer, with taxonomy code 2255A2300X.

When was this NPI record last updated?

The NPPES record for Stacy Lake was last updated on November 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.