Active NPI
Jacqueline Kennedy Millward, MHS, LAT, ATC
- Athletic Trainer
- Fayetteville, NC
National Provider Identifier
1962789859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1717
- Practice address
- 1991 Fordham Dr Ste 100
Fayetteville, NC 28304-3774 - Phone
- (910) 484-3114
- Fax
- (910) 484-8824
- NPI assigned
- Nov 7, 2011
- 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 | 1717 | NC | Primary |
Addresses
Primary practice location
1991 Fordham Dr Ste 100
Fayetteville, NC 28304-3774
Mailing address
1991 Fordham Dr Ste 100
Fayetteville, NC 28304-3774
Phone (910) 484-3114
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 |
|---|---|---|---|
| 1717 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1962789859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1991 FORDHAM DR STE 100",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043774",
"telephone_number": "910-484-3114",
"fax_number": "910-484-8824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1991 FORDHAM DR STE 100",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043774",
"telephone_number": "910-484-3114",
"fax_number": "910-484-8824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLWARD",
"first_name": "JACQUELINE",
"middle_name": "KENNEDY",
"name_prefix": "Mrs.",
"credential": "MHS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-07",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "1717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.