Active NPI
Amy Kathleen Jackson, A.T.C.
- Athletic Trainer
- Hazel Crest, IL
National Provider Identifier
1316054166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 1816 170TH St
Hazel Crest, IL 60429-1451 - Phone
- (708) 335-1415
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- 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 | IL | Primary |
Addresses
Primary practice location
1816 170TH St
Hazel Crest, IL 60429-1451
Mailing address
1816 170TH St
Hazel Crest, IL 60429-1451
Phone (708) 335-1415
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096.001381 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316054166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1816 170TH ST",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604291451",
"telephone_number": "708-335-1415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1816 170TH ST",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604291451",
"telephone_number": "708-335-1415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "AMY",
"middle_name": "KATHLEEN",
"credential": "A.T.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hazel Crest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.