Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Stacy Ellen Lake, ATC

Individual provider Athletic Trainer · NPI 1912274663

Stacy Ellen Lake, ATC is an Athletic Trainer in Fort Wayne, Indiana. Licensed in Indiana. Registered with an NPI since 2011.

Licensed in
IN
In the registry since
2011
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

14730 Pulver Rd
Fort Wayne, IN 46845-9629
Phone: (260) 413-6770
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence 36000573A (IN)

Record details

NPI number1912274663
Entity typeIndividual (Type 1)
GenderFemale
Credentials ATC
Sole proprietorNo
NPI enumeratedNovember 23, 2011
Last updated in NPPESNovember 23, 2011

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