Active NPI
Jaclyn Stucker, MA, LAT, ATC
- Athletic Trainer
- Geneva, NY
National Provider Identifier
1407213754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 003053-1
- Practice address
- 300 Pulteney St
Bristol Gymnasium
Geneva, NY 14456-3304 - Phone
- (315) 481-5698
- NPI assigned
- Jan 18, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | 003053-1 | NY | Primary |
Addresses
Primary practice location
300 Pulteney St
Bristol Gymnasium
Geneva, NY 14456-3304
Mailing address
300 Pulteney St
Bristol Gymnasium
Geneva, NY 14456-3304
Phone (315) 481-5698
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003053-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453075200000",
"number": "1407213754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 PULTENEY ST",
"address_2": "BRISTOL GYMNASIUM",
"city": "GENEVA",
"state": "NY",
"postal_code": "144563304",
"telephone_number": "315-481-5698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PULTENEY ST",
"address_2": "BRISTOL GYMNASIUM",
"city": "GENEVA",
"state": "NY",
"postal_code": "144563304",
"telephone_number": "315-481-5698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUCKER",
"first_name": "JACLYN",
"credential": "MA, LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-18",
"last_updated": "2016-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "003053-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Geneva, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.