Jessica Dutton, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2505 Issued in MN

Practice address

5 Birchwood Ave
White Bear Lake, MN 55110-1604

Phone

(651) 249-3622

NPI assigned

Sep 17, 2014

Last updated

Sep 17, 2014By 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

State licenses

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410912000000",
    "number": "1972905495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BIRCHWOOD AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551101604",
            "telephone_number": "651-249-3622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 BIRCHWOOD AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551101604",
            "telephone_number": "651-249-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTTON",
        "first_name": "JESSICA",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "2505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Athletic Trainer in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; 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.