Jodie K Timberlake

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

0101257066 Issued in VA

Practice address

2325 5TH St BLDG 675
Wright Patterson AFB, OH 45433-7505

Phone

(937) 257-0837

NPI assigned

Mar 26, 2013

Sex

Female

Sole proprietor

No

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": "1364256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1619219789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 5TH ST BLDG 840",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454337951",
            "telephone_number": "937-938-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 5TH ST BLDG 675",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454337505",
            "telephone_number": "937-257-0837"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Bergquist Dr",
            "address_2": "Willford Hall Ambulatory Surgical Center",
            "address_purpose": "LOCATION",
            "city": "Lackland A F B",
            "state": "TX",
            "postal_code": "782369907",
            "country_code": "US",
            "telephone_number": "210-292-5077",
            "fax_number": "210-292-7868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIMBERLAKE",
        "first_name": "JODIE",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-26",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "VA",
            "license": "0101257066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan K Tallent, D.D.S.
• Austen Tanner, O.D.
• Samuel Raymond Theis, DO
• Dale Roger Tidaback, MD, MPH
• Ryan Timar, MD
• Carter S Tisdale, MD
• Tonya M Toche-Howard, REGISTERED NURSE
• Laura Torres-Reyes, M.D., M.P.H.
• Brandon M Tourtillott, PH.D. CCC-A
• Ryan Lee Traver, O.D.

• Military Health Care Provider in Wright Patterson AFB, OH
• Providers in Wright Patterson AFB, OH by specialty
• Military Health Care Provider in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; 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.