VAN TREECE WOODALL (NPI# 1700309374) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700309374 |
| Entity Type | Individual |
| Full Name | VAN TREECE WOODALL |
| Credential | ATC |
| Practice Address |
1325 E Fortification St Jackson MS 39202-2442 |
| Mailing Address |
304 Robb St Summit MS 39666-7167 |
| Practice Telephone | 6013544488 |
| Mailing Telephone | 6012489676 |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2017-07-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
2000029947 | MS | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
1325 E FORTIFICATION ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386632560 | Chris Phillip Ethridge | Orthopaedic Surgery | 1325 E Fortification St, Jackson, MS 39202-2442 | 2005-10-11 |
| 1144832130 | Georgiana Ogletree | Occupational Therapist | 1325 E Fortification St, Jackson, MS 39202-2442 | 2020-08-20 |
| 1972133353 | Justin Bryant Schopp | Physician Assistant | 1325 E Fortification St, Jackson, MS 39202-2442 | 2020-01-24 |
| 1154951739 | Hailey Daniels Kelly | Physician Assistant | 1325 E Fortification St, Jackson, MS 39202-2442 | 2020-01-22 |
| 1356903520 | James Logan Ferrell | Occupational Therapist | 1325 E Fortification St, Jackson, MS 39202-2442 | 2019-07-08 |
| 1184185472 | Jamie Jackson Garrett | Physician Assistant | 1325 E Fortification St, Jackson, MS 39202-2442 | 2019-03-28 |
| 1114494754 | Charles Taylor Knapp | Nurse Practitioner | 1325 E Fortification St, Jackson, MS 39202-2442 | 2018-11-01 |
| 1477078277 | Leah Winstead West | Physical Medicine & Rehabilitation | 1325 E Fortification St, Jackson, MS 39202-2442 | 2017-08-14 |
| 1346760220 | Megan Wallace Tyson | Nurse Practitioner | 1325 E Fortification St, Jackson, MS 39202-2442 | 2017-06-22 |
| 1083149181 | John Causey | Registered Nurse | 1325 E Fortification St, Jackson, MS 39202-2442 | 2017-04-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
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| 1588132161 | John Thomas Raybon | Specialist/Technologist | 328 Portis Ave, Jackson, AL 36545-2650 | 2018-11-13 |
| 1265925044 | Caroline Marie Stevens | Specialist/Technologist | 715 S Grinnell St, Jackson, MI 49203-1685 | 2018-06-07 |
| 1447762067 | Sarah Elisabeth Wilhelm | Specialist/Technologist | 3483 Spring Arbor Rd, Jackson, MI 49203-3637 | 2017-11-05 |
| 1619410388 | Erin Nelson | Specialist/Technologist | 4174 Lancashire Dr, Jackson, MI 49203-5137 | 2016-11-29 |
| 1235681685 | Latesha Fleming | Specialist/Technologist | 241 Glenside Dr, Jackson, MS 39211-4309 | 2016-11-02 |
| 1962855239 | David Miller | Specialist/Technologist | 917 Bellevue Pl, Jackson, MS 39202-2702 | 2016-07-21 |
| 1023488186 | Melanie J Weesies | Specialist/Technologist | 3417 Mayapple Ln Apt 32, Jackson, MI 49201-7199 | 2015-10-01 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.