Healthcare Provider Details

I. General information

NPI: 1598671471
Provider Name (Legal Business Name): HAILEY NICHOLE CARISTO MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21200 N 83RD AVE
PEORIA AZ
85382-2436
US

IV. Provider business mailing address

21200 N 83RD AVE
PEORIA AZ
85382-2436
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-5125
  • Fax:
Mailing address:
  • Phone: 623-487-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR009547
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: