Jacob Vernon Waldecker

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT8210 Issued in TX

Practice address

14651 Horizon Blvd
Horizon City, TX 79928-8639

Phone

(270) 823-3597

NPI assigned

Jan 28, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1801549035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14651 HORIZON BLVD",
            "city": "HORIZON CITY",
            "state": "TX",
            "postal_code": "799288639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14651 HORIZON BLVD",
            "city": "HORIZON CITY",
            "state": "TX",
            "postal_code": "799288639",
            "telephone_number": "270-823-3597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDECKER",
        "first_name": "JACOB",
        "middle_name": "VERNON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT8210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "rankonesport.com",
            "affiliation": "N",
            "endpointDescription": "athletic healthcare information system",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14651 Horizon Blvd",
            "city": "Horizon City",
            "state": "TX",
            "country_code": "US",
            "postal_code": "799288639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Horizon City, TX
• Providers in Horizon City, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.