Jillian Frances Nicholson, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1059-039 Issued in WI

Practice address

6119 CTH Y # 13
Hazelhurst, WI 54531-9762

Phone

(715) 564-4326

NPI assigned

Mar 4, 2010

Last updated

Aug 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1267660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1669795753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6119 CTH Y # 13",
            "city": "HAZELHURST",
            "state": "WI",
            "postal_code": "545319762",
            "telephone_number": "715-564-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6119 CTH Y # 13",
            "city": "HAZELHURST",
            "state": "WI",
            "postal_code": "545319762",
            "telephone_number": "715-564-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "JILLIAN",
        "middle_name": "FRANCES",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-04",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "1059-039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOC CERTIFICATION NUMBER",
            "identifier": "2000000365",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI STATE LICENSURE",
            "identifier": "1059-039",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Andrews, RN
• Patricia Lynn Duncan, RN BSN
• Front Office Back Office Automation (Ashford Home Care Wisconsin)
• Carol A Maki, RD, CDE
• Kelley J. Moran, R.D.H., C.D.H.C.
• Jackie Rogers, RN

• Athletic Trainer in Hazelhurst, WI
• Providers in Hazelhurst, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.