Active NPI
Bradley Jackson
- Athletic Trainer
- Lynchburg, VA
National Provider Identifier
1700285665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 1501 Lakeside Dr
Lynchburg, VA 24501-3113 - Phone
- (434) 544-8100
- NPI assigned
- Aug 16, 2014
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
1501 Lakeside Dr
Lynchburg, VA 24501-3113
Mailing address
5050 Rolling Rock Rd
Rocky Mount, NC 27803-9037
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408147200000",
"number": "1700285665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5050 ROLLING ROCK RD",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278039037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 LAKESIDE DR",
"city": "LYNCHBURG",
"state": "VA",
"postal_code": "245013113",
"telephone_number": "434-544-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BRADLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-16",
"last_updated": "2014-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynchburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.