Active NPI
Jenica Myrea Paulsen, A.T.C.
- Athletic Trainer
- Springfield, MO
National Provider Identifier
1346658747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2014022273
- Practice address
- 901 S National Ave
Springfield, MO 65897-0027 - Phone
- (417) 836-5461
- NPI assigned
- Jul 29, 2014
- 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 | 2014022273 | MO | Primary |
Addresses
Primary practice location
901 S National Ave
Springfield, MO 65897-0027
Mailing address
901 S National Ave
Springfield, MO 65897-0027
Phone (417) 836-5461
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649341272 | Other | MO | FACILITY NPI NUMBER |
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 |
|---|---|---|---|
| 2014022273 | MO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406592000000",
"number": "1346658747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 S NATIONAL AVE",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658970027",
"telephone_number": "417-836-5461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 S NATIONAL AVE",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658970027",
"telephone_number": "417-836-5461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULSEN",
"first_name": "JENICA",
"middle_name": "MYREA",
"credential": "A.T.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-29",
"last_updated": "2014-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2014022273",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FACILITY NPI NUMBER",
"identifier": "1649341272",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.