Jessica Deforrest, MA, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1755 Issued in MN

Practice address

4080 W Broadway Ave Ste 300
Robbinsdale, MN 55422-5607

Phone

(651) 231-8379

NPI assigned

Nov 26, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1322265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322265600000",
    "number": "1508133190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 HICKORY LN N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551287037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 W BROADWAY AVE STE 300",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554225607",
            "telephone_number": "651-231-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFORREST",
        "first_name": "JESSICA",
        "credential": "MA, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-26",
        "last_updated": "2011-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "1755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Davidson, PT, DPT
• Brian J De Michaelis, MD
• Daniela G Dean, RN, CNP
• Stefan L Deboel, MD
• Ashley Marie Deckman, CGC
• Jennifer Mina Deisler, APRN, CNP
• Lee Warren Dekrey, DMD
• Bradly Delong, LPCC
• Nicole Des Marais
• Guy Deutschman, RRT

• Athletic Trainer in Robbinsdale, MN
• Providers in Robbinsdale, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2011; 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.