Active NPI
Jessica Gideon
- Physical Therapy Assistant
- Humboldt, TN
National Provider Identifier
1053845131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 6266
- Practice address
- 3525 Chere Carol Rd
Humboldt, TN 38343-3638 - Phone
- (731) 824-5551
- Fax
- (731) 824-5568
- NPI assigned
- Apr 17, 2017
- Last updated
- Apr 17, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 6266 | TN | Primary |
Addresses
Primary practice location
3525 Chere Carol Rd
Humboldt, TN 38343-3638
Mailing address
1804 Highway 45 Byp
Suite 604
Jackson, TN 38305-4436
Phone (731) 660-7971
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6266 | TN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492387200000",
"number": "1053845131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 HIGHWAY 45 BYP",
"address_2": "SUITE 604",
"city": "JACKSON",
"state": "TN",
"postal_code": "383054436",
"telephone_number": "731-660-7971",
"fax_number": "731-660-8739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3525 CHERE CAROL RD",
"city": "HUMBOLDT",
"state": "TN",
"postal_code": "383433638",
"telephone_number": "731-824-5551",
"fax_number": "731-824-5568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIDEON",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-17",
"last_updated": "2017-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "6266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Humboldt, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.