Henry William Jacobs, BS, BA, MSAT STUDENT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1475 Engineering Dr
Madison, WI 53706-1607

Phone

(608) 264-8065

NPI assigned

Oct 22, 2024

Sex

Male

Sole proprietor

Yes

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

Credentials

Bachelor of Arts, Bachelor of Science

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

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1053132928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5673 CHERYL DR",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537115371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 ENGINEERING DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537061607",
            "telephone_number": "608-264-8065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "HENRY",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "BS, BA, MSAT STUDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Ann Jackson, N.P.
• Tyeshia Jackson
• Alexis Danielle Jacob, M.D.
• Gary Matthew Jacoboski, LPC-IT
• Cameron Jordan Jacobs
• Janet Elizabeth Jacobs, LPC
• Melissa Jacobs, RDH
• Suzanne M Jacobs, CRNA
• Lindsey Marie Jacobsen, LCSW
• Andrea Jacobson, BS

• Athletic Trainer in Madison, WI
• Providers in Madison, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.