Jacqueline Durst, ATC, LAT

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

A00192 Issued in MD

Practice address

101 Braddock Rd
Frostburg State University Kinesiology Department
Frostburg, MD 21532-2303

Phone

(301) 697-2801

NPI assigned

Apr 16, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429142400000",
    "number": "1003203068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 FROST AVE",
            "city": "FROSTBURG",
            "state": "MD",
            "postal_code": "215321623",
            "telephone_number": "301-697-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BRADDOCK RD",
            "address_2": "FROSTBURG STATE UNIVERSITY KINESIOLOGY DEPARTMENT",
            "city": "FROSTBURG",
            "state": "MD",
            "postal_code": "215322303",
            "telephone_number": "301-697-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURST",
        "first_name": "JACQUELINE",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "MD",
            "license": "A00192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Marie Dennis
• Autumn Devore
• Diane D Romaine, DMD, PA
• Mandi Rose Dixon
• Elizabeth Marie Durst, LMSW
• Adam Samuel Dwyer
• Amy Edwards, LMT
• Mandi Emerick, COTA/L
• Family Therapy Services
• Frostburg Area Ambulance Service Inc

• Sports Medicine (Emergency Medicine) Physician in Frostburg, MD
• Providers in Frostburg, MD by specialty
• Sports Medicine (Emergency Medicine) Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.