Active NPI
Jordan Faison, PHARMD
- Athletic Trainer
- Wisconsin Rapids, WI
National Provider Identifier
1700424090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 19200-40
- Practice address
- 900 E Riverview Expy
Wisconsin Rapids, WI 54494-5482 - Phone
- (715) 631-7177
- NPI assigned
- Dec 17, 2019
- 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 | 19200-40 | WI | Primary |
Addresses
Primary practice location
900 E Riverview Expy
Wisconsin Rapids, WI 54494-5482
Mailing address
900 E Riverview Expy
Wisconsin Rapids, WI 54494-5482
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19200-40 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576540800000",
"number": "1700424090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 E RIVERVIEW EXPY",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "544945482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 E RIVERVIEW EXPY",
"city": "WISCONSIN RAPIDS",
"state": "WI",
"postal_code": "544945482",
"telephone_number": "715-631-7177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAISON",
"first_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-17",
"last_updated": "2019-12-17",
"certification_date": "2019-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "19200-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wisconsin Rapids, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.