Individual provider Active NPI

Leigh Ann Gaines, AT

  • Athletic Trainer
  • Jackson, TN
National Provider Identifier
1396365573
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
689 Issued in TN
Practice address
343 Vann Dr
Jackson, TN 38305-6018
Phone
(731) 984-7640
NPI assigned
Apr 17, 2020
Last updated
Apr 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 689 TN Primary

Addresses

Primary practice location

343 Vann Dr
Jackson, TN 38305-6018

Mailing address

1804 Highway 45 Byp Ste 604
Jackson, TN 38305-4403
Phone (731) 660-7971

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

LicenseStateTypeSpecialty
689TNMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1396365573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP STE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054403",
            "telephone_number": "731-660-7971",
            "fax_number": "731-660-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 VANN DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383056018",
            "telephone_number": "731-984-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAINES",
        "first_name": "LEIGH ANN",
        "credential": "AT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": "689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.