Allison Nicole Jackson, AT

Key facts

NPI

1669845210

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

AT. 004757 (OH)

Practice address

190 Waller Dr
Crittenden, KY 41030-8723

Phone

(859) 803-3993

NPI assigned

Nov 4, 2015

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 4, 2015.

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446595200000",
    "number": "1669845210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 WALLER DR",
            "city": "CRITTENDEN",
            "state": "KY",
            "postal_code": "410308723",
            "telephone_number": "859-803-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 WALLER DR",
            "city": "CRITTENDEN",
            "state": "KY",
            "postal_code": "410308723",
            "telephone_number": "859-803-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALLISON",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "AT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2015-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT. 004757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Crittenden, KY · Athletic Trainer in Kentucky