Active NPI
Jonae Demetra Pedersen
- Athletic Trainer
- Norfolk, VA
National Provider Identifier
1487277018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126003760
- Practice address
- 601 Childrens LN
Norfolk, VA 23507-1910 - Phone
- (757) 668-7000
- NPI assigned
- May 18, 2020
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126003760 | VA | Primary |
Addresses
Primary practice location
601 Childrens LN
Norfolk, VA 23507-1910
Mailing address
126 Rosewood Dr
Suffolk, VA 23434-7711
Phone (757) 572-6877
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
| License | State | Type | Specialty |
|---|---|---|---|
| 0126003760 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746403200000",
"number": "1487277018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 ROSEWOOD DR",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234347711",
"telephone_number": "757-572-6877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 CHILDRENS LN",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235071910",
"telephone_number": "757-668-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "JONAE",
"middle_name": "DEMETRA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-18",
"last_updated": "2025-05-05",
"certification_date": "2025-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126003760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.