Jennifer Wallace, MS, ATC/L

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1197 Issued in AL

Practice address

806 Patton Chapel TRL
Hoover, AL 35226-2254

Phone

(256) 436-1165

NPI assigned

Oct 7, 2014

Last updated

Oct 7, 2014By the provider in NPPES

Sex

Female

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

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1174926984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 PATTON CHAPEL TRL",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352262254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 PATTON CHAPEL TRL",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352262254",
            "telephone_number": "256-436-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JENNIFER",
        "credential": "MS, ATC/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AL",
            "license": "1197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #13937)
• Ashley Walker, MD
• Bailey Adams Walker, DDS
• Emily V. Walker, CRNP
• Thomas Walker
• Jonathan Wesley Walter, MD
• Tina Ford Walton, P.T.
• Alycia Wang
• Ashley Nicole Ward
• Lauren Hill Ward, PHARMD

• Athletic Trainer in Hoover, AL
• Providers in Hoover, AL by specialty
• Athletic Trainer in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.