Healthcare Provider Details

I. General information

NPI: 1396995312
Provider Name (Legal Business Name): JODI MCCONNELL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CAMPUS BOX ELON UNIVERSITY AT DEPARTMENT
ELON NC
27244
US

IV. Provider business mailing address

2500 CAMPUS BOX ELON UNIVERSITY AT DEPARTMENT
ELON NC
27244-2952
US

V. Phone/Fax

Practice location:
  • Phone: 336-278-6800
  • Fax: 336-278-6767
Mailing address:
  • Phone: 336-278-6800
  • Fax: 336-278-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberNC1250
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNC1250
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: