Jeffrey John Eddy, COF, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

00194 Issued in MO

Practice address

12984 Maurer Industrial Dr
Saint Louis, MO 63127-1564

Phone

(314) 842-6750

Fax

(314) 842-6761

NPI assigned

Mar 2, 2021

Sex

Male

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

State licenses

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

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1548855513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 LANDS END CIR",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633045018",
            "telephone_number": "636-236-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12984 MAURER INDUSTRIAL DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271564",
            "telephone_number": "314-842-6750",
            "fax_number": "314-842-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDY",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "COF, ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-02",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "00194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalisha Eddington, CERTIFIED DOULA
• Kathleen Elizabeth Eddington, MSN, RN
• Christina Eddins, MOTR/L
• Daniel Raymond Eddins, CRNA
• Julia A Eddins, MSN, AGACNP-BC
• Mark C Eddy, MD
• Adam J Edelman, M.D.
• Tracy Lynn Edelmann, D.C.
• Brian Todd Edelson, M.D., PH.D.
• Sean Lewis Edelstein, MD

• Athletic Trainer in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.