Active NPI
Jeffrey Jackson
- Athletic Trainer
- Ontario, OR
National Provider Identifier
1235929720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1251458524
- Practice address
- 1294 SW 4TH Ave
Ontario, OR 97914-4567 - Phone
- (208) 414-2639
- NPI assigned
- May 8, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 | 1251458524 | Primary |
Addresses
Primary practice location
1294 SW 4TH Ave
Ontario, OR 97914-4567
Mailing address
744 NW 1St Ave
Ontario, OR 97914-2204
Phone (208) 514-7624
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746748800000",
"number": "1235929720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "744 NW 1ST AVE",
"city": "ONTARIO",
"state": "OR",
"postal_code": "979142204",
"telephone_number": "208-514-7624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1294 SW 4TH AVE",
"city": "ONTARIO",
"state": "OR",
"postal_code": "979144567",
"telephone_number": "208-414-2639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JEFFREY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-08",
"last_updated": "2025-05-09",
"certification_date": "2025-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": "1251458524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.