Melissa Jack, DAT, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

15826 Roxton Ridge Dr
Webster, TX 77598-2544

Phone

(484) 515-5728

NPI assigned

Mar 6, 2013

Last updated

Jul 30, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1952642639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15826 ROXTON RIDGE DR",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775982544",
            "telephone_number": "484-515-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15826 ROXTON RIDGE DR",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775982544",
            "telephone_number": "484-515-5728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 New Bellevue Ave",
            "address_2": "Apt 1603",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321145665",
            "country_code": "US",
            "telephone_number": "484-515-5728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "MELISSA",
        "credential": "DAT, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-06",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Niranjan G Iyer, M.D.
• Jesseca Lynn Izquierdo, CNP
• Sakher Samer Ja'Anini, M.D.
• Sanjeeda Jabeen, MD
• Floy Christine Jabot, RBT
• Alexandria Blair Jackson, AU.D.
• Sarah Ann Jackson
• Amy R. Jacobs, N.P.
• Jacquin a Coombs MD PLLC
• Syed Hyder Jaffery, M.D.

• Athletic Trainer in Webster, TX
• Providers in Webster, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.

Verify at the official NPI Registry.