Jacoby Markie Clemons, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1201 West Leroy Pond Dr
Fayetteville, AR 72701

Phone

(585) 317-5771

NPI assigned

May 31, 2018

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1225520828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036 S DUNN AVE # 204A",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015529",
            "telephone_number": "585-317-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 WEST LEROY POND DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72701",
            "telephone_number": "585-317-5771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "JACOBY",
        "middle_name": "MARKIE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David W Clay, MD
• Clear Vision Clinic PLLC
• Melissa Nicole Cleaveland
• Cleft & Craniofacial Center of Nwa
• Julia Clem, MD
• Susan D Clemons, PHD.
• Courtney Cleverdon
• Client Focused Counseling
• Jeremy Brian Clift
• Heather Clifton

• All providers in Fayetteville, AR
• Athletic Trainer in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; 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.