Active NPI
Isaac T. Jackson, ATHLETIC TRAINER
- Health & Wellness Coach
- Brandywine, MD
National Provider Identifier
1134937725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health & Wellness Coach
- License
- 1241364241
- Practice address
- 3916 Woodreed Dr
Brandywine, MD 20613-6006 - Phone
- (301) 526-8416
- NPI assigned
- Dec 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Health & Wellness Coach | 171400000X | 1241364241 | MD | Primary |
Addresses
Primary practice location
3916 Woodreed Dr
Brandywine, MD 20613-6006
Mailing address
3916 Woodreed Dr
Brandywine, MD 20613-6006
Phone (301) 526-8416
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 |
|---|---|---|---|
| 1241364241 | MD | MD | Health & Wellness Coach |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735257600000",
"number": "1134937725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3916 WOODREED DR",
"city": "BRANDYWINE",
"state": "MD",
"postal_code": "206136006",
"telephone_number": "301-526-8416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3916 WOODREED DR",
"city": "BRANDYWINE",
"state": "MD",
"postal_code": "206136006",
"telephone_number": "301-526-8416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ISAAC",
"middle_name": "T.",
"credential": "ATHLETIC TRAINER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-27",
"last_updated": "2024-12-27",
"certification_date": "2024-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "171400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Health & Wellness Coach",
"state": "MD",
"license": "1241364241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandywine, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.