Active NPI
Justine Nuckols, ATC
- Athletic Trainer
- Jacksonville, NC
National Provider Identifier
1952136780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-5115
- Practice address
- G644 Ivy Hall RM 134 6TH St.
Jacksonville, NC 28542 - Phone
- (910) 449-0276
- NPI assigned
- Sep 3, 2024
- Last updated
- Sep 3, 2024
- 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 | LAT-5115 | NC | Primary |
Addresses
Primary practice location
G644 Ivy Hall RM 134 6TH St.
Jacksonville, NC 28542
Mailing address
308 Gracie Farms Rd
New Bern, NC 28560-9373
Phone (360) 589-6301
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-5115 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1725321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1952136780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 GRACIE FARMS RD",
"city": "NEW BERN",
"state": "NC",
"postal_code": "285609373",
"telephone_number": "360-589-6301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "G644 IVY HALL RM 134 6TH ST.",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "28542",
"telephone_number": "910-449-0276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUCKOLS",
"first_name": "JUSTINE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-03",
"last_updated": "2024-09-03",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-5115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
- Northwoods Drug Co Inc
- Novant Health Medical Group Coastal Region, LLC (Novant Health Family Medicine Jacksonville)
- Novant Health Medical Group Coastal Region, LLC (NHMGCR Family Medicine)
- Novant Health Medical Group NC Coastal Region Specialty, LLC (Novant Health Cancer Institute)
- Maria De Fatima Novo, RBT
- Nuday Companion Care Services
- James Jay Nunalee Jr., PHARMD
- Austin Uzoma Nwameme, B-PHARM
- O-Aysist, PLLC
- Christopher C O'Brian, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.