Active NPI
Shanickwa Jackson
- Athletic Trainer
- Hattiesburg, MS
National Provider Identifier
1326560319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT0857
- Practice address
- 7 Lakewood Dr
Hattiesburg, MS 39402-9425 - Phone
- (985) 237-2994
- NPI assigned
- Jul 11, 2017
- Sex
- Female
- Sole proprietor
- No
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 | AT0857 | MS | Primary |
Addresses
Primary practice location
7 Lakewood Dr
Hattiesburg, MS 39402-9425
Mailing address
7 Lakewood Dr
Hattiesburg, MS 39402-9425
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 |
|---|---|---|---|
| AT0857 | MS | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499731200000",
"number": "1326560319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 LAKEWOOD DR",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394029425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 LAKEWOOD DR",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394029425",
"telephone_number": "985-237-2994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHANICKWA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-11",
"last_updated": "2017-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MS",
"license": "AT0857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.