Active NPI
Jordan Samantha Devenney, MS, LAT, ATC
- Athletic Trainer
- Lafayette, IN
National Provider Identifier
1942693007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36003182A
- Practice address
- 3001 S Creasy LN Ste B
Lafayette, IN 47905-5206 - Phone
- (269) 718-9333
- NPI assigned
- Mar 13, 2015
- Sex
- Female
- Sole proprietor
- No
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 | 36003182A | IN | Primary |
Addresses
Primary practice location
3001 S Creasy LN Ste B
Lafayette, IN 47905-5206
Mailing address
3101 New London CT Apt 510
Lafayette, IN 47909-5312
Phone (269) 718-9333
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36003182A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580688000000",
"number": "1942693007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3101 NEW LONDON CT APT 510",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479095312",
"telephone_number": "269-718-9333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 S CREASY LN STE B",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479055206",
"telephone_number": "269-718-9333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVENNEY",
"first_name": "JORDAN",
"middle_name": "SAMANTHA",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-13",
"last_updated": "2020-02-03",
"certification_date": "2020-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36003182A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.