Individual provider Active NPI

Jennifer Dorman, ATC

  • Athletic Trainer
  • Cordova, TN
National Provider Identifier
1679971659
Registry record updated Dec 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
0000001752 Issued in TN
Practice address
7600 Macon Rd
Cordova, TN 38018-4900
Phone
(901) 754-7217
NPI assigned
Dec 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 0000001752 TN Primary

Addresses

Primary practice location

7600 Macon Rd
Cordova, TN 38018-4900

Mailing address

6286 Briarcrest Ave
Memphis, TN 38120-4023
Phone (901) 237-3301

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

LicenseStateTypeSpecialty
0000001752TNMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417996800000",
    "number": "1679971659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6286 BRIARCREST AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381204023",
            "telephone_number": "901-237-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 MACON RD",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380184900",
            "telephone_number": "901-754-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORMAN",
        "first_name": "JENNIFER",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-08",
        "last_updated": "2014-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TN",
            "license": "0000001752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.