Laura Permelia Jackson, M.S.ED.,ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AL3704 Issued in FL

Practice address

3300 Airport Road
Southern Pines, NC 28387

Phone

(910) 692-6920

NPI assigned

Aug 1, 2016

Sex

Female

Sole proprietor

Yes

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": "1470009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470009600000",
    "number": "1497208987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283880290",
            "telephone_number": "910-692-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 AIRPORT ROAD",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "28387",
            "telephone_number": "910-692-6920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAURA",
        "middle_name": "PERMELIA",
        "credential": "M.S.ED.,ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-01",
        "last_updated": "2016-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "002200",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL3704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Pain Solutions PLLC
• Invictus Counseling
• Amy S. Ivey, C.P.N.P.
• Amanda R Jackson, BCAT
• Heather Jackson, LBMT
• Nicole Jacobs, MD
• Fredena Lucas Jaggers, CRNA
• Thomas Scott Jamison, MD
• Jeffrey S. Almony, MD, DDS, PA
• Jody McCain, PSYD PLLC

• Athletic Trainer in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Athletic Trainer in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.

Verify at the official NPI Registry.