Jackson Wade McQueen, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

3300 W Camelback Rd # A21367
Phoenix, AZ 85017-3030

Phone

(325) 977-1914

NPI assigned

Nov 22, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1780341032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 PENROSE ST",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769038638",
            "telephone_number": "325-977-1914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 W CAMELBACK RD # A21367",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850173030",
            "telephone_number": "325-977-1914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Mountain View Pkwy",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "75211",
            "country_code": "US",
            "telephone_number": "210-333-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCQUEEN",
        "first_name": "JACKSON",
        "middle_name": "WADE",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-22",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christi McQuaid-Bice, OT
• Anne I McQuaid, LPC, LISAC
• Danny Walter McQuain, CRNA
• Elizabeth Shipp McQueary, OTR/L
• Alicia McQueen
• Michael Covert McQueen, M.D.
• Stephen Brian McQueen, R.PH.
• Leila M McQuillan, RN
• Ashley N McQuinn
• Veronika McQuiston

• Athletic Trainer in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Athletic Trainer in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; 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.