Jeremy David Stevens, MS, LAT, ATC, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT006850 Issued in PA

Practice address

345 School Dr
Fredericksburg, PA 17026

Phone

(717) 376-7518

NPI assigned

Jun 23, 2015

Last updated

Apr 26, 2024By the provider in NPPES

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

Master of Science

State licenses

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1073995312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 SCHOOL DR",
            "city": "FREDERICKSBURG",
            "state": "PA",
            "postal_code": "170269229",
            "telephone_number": "717-376-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 SCHOOL DR",
            "city": "FREDERICKSBURG",
            "state": "PA",
            "postal_code": "17026",
            "telephone_number": "717-376-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "credential": "MS, LAT, ATC, OTC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-23",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT006850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Fredericksburg, PA
• Providers in Fredericksburg, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.