Healthcare Provider Details

I. General information

NPI: 1023587482
Provider Name (Legal Business Name): JESSICA USELDING LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 MATLOCK RD
ARLINGTON TX
76015-3604
US

IV. Provider business mailing address

4210 DECHMAN DR APT 4114
GRAND PRAIRIE TX
75052-6897
US

V. Phone/Fax

Practice location:
  • Phone: 817-419-0303
  • Fax:
Mailing address:
  • Phone: 214-926-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT8695
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: