Jessica Kendall, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1124 Issued in SC

Practice address

579 Burcale Rd
Myrtle Beach, SC 29579-8329

Phone

(801) 243-8901

NPI assigned

Mar 10, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268179200000",
    "number": "1194048736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 HAMMOND RD",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041051910",
            "telephone_number": "801-243-8901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "579 BURCALE RD",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295798329",
            "telephone_number": "801-243-8901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDALL",
        "first_name": "JESSICA",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-10",
        "last_updated": "2010-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "67110614810",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "1124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Kelly, FNP
• Mary B Kelly, NP
• Tyler Kelly, DO
• Kemper Therapy Group LLC
• Devin A Kemper, CCC-SLP
• Adam Kendig, PTA
• Amber Elizabeth Kendig, MS, CCC-SLP
• Kenneth T Cappuccio LLC
• Heather Kerble
• William Kerr

• All providers in Myrtle Beach, SC
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; 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.