Active NPI
Jackie Vogan, PTA
- Physical Therapy Assistant
- Rushville, MO
National Provider Identifier
1154719755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 14-02607
- Practice address
- 209 Lakeshore Dr
Rushville, MO 64484-9531 - Phone
- (816) 261-2414
- NPI assigned
- Jan 5, 2015
- 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 | 14-02607 | KS | Primary |
Addresses
Primary practice location
209 Lakeshore Dr
Rushville, MO 64484-9531
Mailing address
209 Lakeshore Dr
Rushville, MO 64484-9531
Phone (816) 261-2414
Other names 1
- Jackie Lynn Boyd
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 |
|---|---|---|---|
| 14-02607 | KS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420416000000",
"number": "1154719755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 LAKESHORE DR",
"city": "RUSHVILLE",
"state": "MO",
"postal_code": "644849531",
"telephone_number": "816-261-2414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 LAKESHORE DR",
"city": "RUSHVILLE",
"state": "MO",
"postal_code": "644849531",
"telephone_number": "816-261-2414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VOGAN",
"first_name": "JACKIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-05",
"last_updated": "2015-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KS",
"license": "14-02607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACKIE",
"last_name": "BOYD",
"middle_name": "LYNN",
"credential": "PTA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Rushville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.