Active NPI
Jacqueline Phillips, MS, ATC
- Athletic Trainer
- Grand Rapids, MI
National Provider Identifier
1073912895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601002859
- Practice address
- 2770 E Beltline Ave NE
Grand Rapids, MI 49525-8614 - Phone
- (616) 267-8860
- Fax
- (616) 267-8442
- NPI assigned
- Aug 18, 2014
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2601002859 | MI | Primary |
Addresses
Primary practice location
2770 E Beltline Ave NE
Grand Rapids, MI 49525-8614
Mailing address
2770 E Beltline Ave NE
Grand Rapids, MI 49525-8614
Phone (616) 267-8860
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601002859 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764288000000",
"number": "1073912895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2770 E BELTLINE AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495258614",
"telephone_number": "616-267-8860",
"fax_number": "616-267-8442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2770 E BELTLINE AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495258614",
"telephone_number": "616-267-8860",
"fax_number": "616-267-8442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "JACQUELINE",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-18",
"last_updated": "2025-11-28",
"certification_date": "2025-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601002859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.