Active NPI
Jessica Lynn Childers, PT
- Physical Therapist
- Johnson City, TN
National Provider Identifier
1366752032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8287
- Practice address
- 3 Professional Park Dr
Suite 10
Johnson City, TN 37604-6529 - Phone
- (423) 926-4331
- NPI assigned
- Oct 15, 2010
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8287 | TN | Primary |
Addresses
Primary practice location
3 Professional Park Dr
Suite 10
Johnson City, TN 37604-6529
Mailing address
3 Professional Park Dr
Suite 10
Johnson City, TN 37604-6529
Phone (423) 926-4331
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8287 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287360000000",
"number": "1366752032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 PROFESSIONAL PARK DR",
"address_2": "SUITE 10",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046529",
"telephone_number": "423-926-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 PROFESSIONAL PARK DR",
"address_2": "SUITE 10",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046529",
"telephone_number": "423-926-4331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDERS",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-15",
"last_updated": "2010-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "8287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.