MEDICARE: JESSICA HARTFORD ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1043728595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HARTFORD ATC

Provider Business Mailing Address
First Line	:	7270 E CANTERBURY LN
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-9430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 LAKE LOWELL AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6654
Country	:	US
Telephone Number	:	406-239-1878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	09/15/2021

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