Jessica Alysse Vlisides-Henry

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

11323315-4810 Issued in UT

Practice address

2330 Lincoln Ave
Ogden, UT 84401-1304

Phone

(248) 410-4677

NPI assigned

Jan 10, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1437666526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4374 S MAIN ST UNIT 520",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841073377",
            "telephone_number": "248-410-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 LINCOLN AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011304",
            "telephone_number": "248-410-4677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 W Center St Apt 166",
            "address_purpose": "LOCATION",
            "city": "North Salt Lake",
            "state": "UT",
            "postal_code": "840542553",
            "country_code": "US",
            "telephone_number": "248-410-4677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VLISIDES-HENRY",
        "first_name": "JESSICA",
        "middle_name": "ALYSSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-10",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "11323315-4810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kevin Vore, MOTR/L
• Jocelyn Vranes

• Athletic Trainer in Ogden, UT
• Providers in Ogden, UT by specialty
• Athletic Trainer in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.