Active NPI
Jessica Wilson, ATC, LAT
- Athletic Trainer
- Little Rock, AR
National Provider Identifier
1629511977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT762
- Practice address
- 10301 Kanis Rd
Little Rock, AR 72205-6205 - Phone
- (501) 604-6900
- NPI assigned
- Nov 18, 2016
- Last updated
- Nov 18, 2016
- Sex
- Female
- Sole proprietor
- No
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 | AT762 | AR | Primary |
Addresses
Primary practice location
10301 Kanis Rd
Little Rock, AR 72205-6205
Mailing address
10301 Kanis Rd
Little Rock, AR 72205-6205
Phone (501) 604-6900
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 |
|---|---|---|---|
| AT762 | AR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479427200000",
"number": "1629511977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10301 KANIS RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722056205",
"telephone_number": "501-604-6900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10301 KANIS RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722056205",
"telephone_number": "501-604-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JESSICA",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-18",
"last_updated": "2016-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "AT762",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.