Jada Vanderlip, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1142 Issued in SC

Practice address

115 Sandy Knowe LN
Pawleys Island, SC 29585-6934

Phone

(843) 458-5392

NPI assigned

Jan 14, 2016

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": "1452729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452729600000",
    "number": "1306202718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 SANDY KNOWE LN",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295856934",
            "telephone_number": "843-458-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 SANDY KNOWE LN",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295856934",
            "telephone_number": "843-458-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERLIP",
        "first_name": "JADA",
        "name_prefix": "Mrs.",
        "credential": "MS, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "1142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Pawleys Island, SC
• Providers in Pawleys Island, SC by specialty
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.

Verify at the official NPI Registry.