Active NPI
Jacky Brenton, ATC
- Athletic Trainer
- Pueblo, CO
National Provider Identifier
1699381244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT.0001926
- Practice address
- 3676 Parker Blvd Ste 310
Pueblo, CO 81008-2214 - Phone
- (719) 595-7780
- NPI assigned
- Sep 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | AT.0001926 | CO | Primary |
Addresses
Primary practice location
3676 Parker Blvd Ste 310
Pueblo, CO 81008-2214
Mailing address
PO Box 8066
Pueblo, CO 81008
Phone (719) 289-5809
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 |
|---|---|---|---|
| AT.0001926 | CO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600387200000",
"number": "1699381244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8066",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81008",
"telephone_number": "719-289-5809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3676 PARKER BLVD STE 310",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810082214",
"telephone_number": "719-595-7780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENTON",
"first_name": "JACKY",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-18",
"last_updated": "2020-09-18",
"certification_date": "2020-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CO",
"license": "AT.0001926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.