KAITLYN NICOLE EDISON — NPI 1104388958 (Licensed & Credentialed Specialist/Technologist, Athletic Trainer in SAINT CHARLES, MO)

CMS-1500 Box 24J / 33a • NPI

1104388958

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

2255A2300X

Licensed & Credentialed Specialist/Technologist, Athletic Trainer

Box 32 Service Location & ZIP+4

2549 HACKMANN RD, SAINT CHARLES, MO, 63303-5452

✓ 9-Digit EDI 837 ZIP+4 (63303-5452)

Practice Phone & Referral Fax

(636) 851-4900

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104388958 (KAITLYN NICOLE EDISON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104388958` (NPI-1 Individual Practitioner)
Provider / Legal Name	KAITLYN NICOLE EDISON
Plain-English Specialty	Licensed & Credentialed Specialist/Technologist, Athletic Trainer NUCC Code: `2255A2300X` (Specialist/Technologist, Athletic Trainer)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2549 HACKMANN RD, SAINT CHARLES, MO, 63303-5452
Practice Telephone / Fax	Tel: (636) 851-4900
Administrative Mailing Address	10717 SAINT BERNARD LN, SAINT ANN, MO, 63074-2519
Enumeration & Last Sync	Enumerated: 2019-04-02 \| CMS Record Updated: 2025-06-18

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2549 HACKMANN RD, SAINT CHARLES, MO, 63303-5452

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Plain-English Taxonomy & CMS Crosswalk (2255A2300X)

What Does Taxonomy Code 2255A2300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2255A2300X translates to:
"Licensed & Credentialed Specialist/Technologist, Athletic Trainer"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Specialist/Technologist, Athletic Trainer for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KAITLYN NICOLE EDISON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2255A2300X` — Specialist/Technologist, Athletic Trainer Plain English: Licensed & Credentialed Specialist/Technologist, Athletic Trainer	State: IL \| License: `096005299` \| Primary: Secondary
`2255A2300X` — Specialist/Technologist, Athletic Trainer Plain English: Licensed & Credentialed Specialist/Technologist, Athletic Trainer	State: MO \| License: `2020035528` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KAITLYN NICOLE EDISON (NPI #1104388958)