Active NPI
Gregory Lee Jackson, MS, ATC
- Athletic Trainer
- Lexington, KY
National Provider Identifier
1356306203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 3821 Everetts DL
Lexington, KY 40514-1185 - Phone
- (859) 351-6789
- NPI assigned
- Apr 20, 2006
- Sex
- Male
- 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 | KY | Primary |
Addresses
Primary practice location
3821 Everetts DL
Lexington, KY 40514-1185
Mailing address
3821 Everetts DL
Lexington, KY 40514-1185
Phone (859) 351-6789
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356306203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3821 EVERETTS DL",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405141185",
"telephone_number": "859-351-6789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3821 EVERETTS DL",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405141185",
"telephone_number": "859-351-6789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GREGORY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "KY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
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.