Jillian Katherine Vervynck
Individual provider Active NPI Athletic Trainer · Canton, MO
NPI 1629937628 · NPPES record last updated Jan 16, 2026
Key facts
- NPI
- 1629937628
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 1 College HL
Canton, MO 63435-1257 - Phone
- (573) 288-6000
- NPI assigned
- Jan 16, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
1 College HL
Canton, MO 63435-1257
Mailing address
409 S 4TH St
Canton, MO 63435-1647
Phone (913) 274-0626
Other providers in Canton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.