Active NPI
Jacqueline Ann Fuentes, LAT,ATC
- Athletic Trainer
- Winston Salem, NC
National Provider Identifier
1174068407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2075
- Practice address
- 120 Charlois Blvd
Winston Salem, NC 27103-1562 - Phone
- (336) 765-5664
- Fax
- (336) 768-6713
- NPI assigned
- Dec 22, 2016
- 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 | 2075 | NC | Primary |
Addresses
Primary practice location
120 Charlois Blvd
Winston Salem, NC 27103-1562
Mailing address
120 Charlois Blvd
Winston Salem, NC 27103-1562
Phone (336) 765-5664
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 |
|---|---|---|---|
| 2075 | NC | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482364800000",
"number": "1174068407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 CHARLOIS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031562",
"telephone_number": "336-765-5664",
"fax_number": "336-768-6713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 CHARLOIS BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271031562",
"telephone_number": "336-765-5664",
"fax_number": "336-768-6713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "JACQUELINE",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LAT,ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-22",
"last_updated": "2016-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "2075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.