Jessica Ann Russell, DAT, MS, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2021013345 Issued in MO

Practice address

1851 Schoettler Rd
Chesterfield, MO 63017-5597

Phone

(636) 230-1756

NPI assigned

Sep 24, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1379980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1992131817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5806 RIVERFRONT DR",
            "city": "PALMYRA",
            "state": "NJ",
            "postal_code": "080652146",
            "telephone_number": "989-415-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 SCHOETTLER RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175597",
            "telephone_number": "636-230-1756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DAT, MS, ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-24",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT005272",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2021013345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thalia Daliz Ruiz
• Victor H Ruiz, MD
• Naris Rujanavech, M.D.
• Rupp Chiropractic LLC
• Rachel A Rush
• Melinda Karole Russell
• Phyllis S Russo, DC
• Raquel K Russo, PA-C
• Debbie Kay Rutledge, RN
• Taedra Marie Rutlin, MA PLPC

• Athletic Trainer in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; 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.