John Leonard Jackson

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

000254 Issued in NY

Practice address

350 New Campus Dr
Brockport, NY 14420-2997

Phone

(585) 395-5374

NPI assigned

Sep 23, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1609482702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NEW CAMPUS DR",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144202997",
            "telephone_number": "585-395-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 NEW CAMPUS DR",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144202997",
            "telephone_number": "585-395-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOHN",
        "middle_name": "LEONARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-23",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "000254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jjackson@brockport.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "113 Delaina Rose Cir",
            "city": "Brockport",
            "state": "NY",
            "country_code": "US",
            "postal_code": "144209344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Lydia Alice Johnson

• Athletic Trainer in Brockport, NY
• Providers in Brockport, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; 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.