Active NPI
Jacky Andreatta, M.AT, LAT, ATC
- Athletic Trainer
- Lufkin, TX
National Provider Identifier
1518404698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT3073
- Practice address
- 1163 Hortons Hollow Rd
Lufkin, TX 75904 - Phone
- (940) 452-0807
- NPI assigned
- Jan 26, 2017
- Sex
- Male
- 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 | AT3073 | TX | Primary |
Addresses
Primary practice location
1163 Hortons Hollow Rd
Lufkin, TX 75904
Mailing address
1 Columbia CT
Lufkin, TX 75901-7212
Phone (940) 452-0807
Other practice location 1
1 Columbia Ct
Lufkin, TX 75901-7212
Phone (940) 452-0807
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 |
|---|---|---|---|
| AT3073 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533772800000",
"number": "1518404698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 COLUMBIA CT",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759017212",
"telephone_number": "940-452-0807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1163 HORTONS HOLLOW RD",
"city": "LUFKIN",
"state": "TX",
"postal_code": "75904",
"telephone_number": "940-452-0807"
}
],
"practiceLocations": [
{
"address_1": "1 Columbia Ct",
"address_purpose": "LOCATION",
"city": "Lufkin",
"state": "TX",
"postal_code": "759017212",
"country_code": "US",
"telephone_number": "940-452-0807",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDREATTA",
"first_name": "JACKY",
"name_prefix": "Mr.",
"credential": "M.AT, LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-26",
"last_updated": "2018-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT3073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
- Eduardo Amadio Anzaloni
- Amedisys Texas LLC (Amedisys Home Health)
- Americare EMS LLC (Americare)
- Penelope Anderson
- Robert W Anderson Jr., OD
- Andrew J. Fercowicz, M.D.,P.a.
- Angel's Choice Home Health Professionals, LLC
- Angelina Alliance for Children
- Angelina County & Cities Health District
- Angelina County Senior Citizens Activities Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.