Jackson Ryan Brunner, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.004944 Issued in IL

Practice address

7160 Athletics Kaufman Football Building
Normal, IL 61790-6953

Phone

(309) 438-0607

NPI assigned

Oct 10, 2018

Last updated

Sep 28, 2021By the provider in NPPES

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

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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1821563453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 ATHLETICS KAUFMAN FOOTBALL BUILDING",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617900001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7160 ATHLETICS KAUFMAN FOOTBALL BUILDING",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617906953",
            "telephone_number": "309-438-0607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "JACKSON",
        "middle_name": "RYAN",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-10",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.004944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meryl Brown, MM, MT-BC, DT
• Alyssa Marie Bruck, MS, OTR/L
• Loryn E Bruer, PT, DPT
• Robert Bruha, MD
• Kristen Marie Brummett, ATC
• Bryan Hinman Counseling PLLC
• Christina M. Burchett, PH.D.
• Jennifer Marie Burge, DDS
• Sara Burge, MS, OTR/L
• Heather Lenae Burnett, APN, NP-C

• Athletic Trainer in Normal, IL
• Providers in Normal, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; 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.