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1467395368 NPI number — MARISSA JACOBSON ATC

NPI Number: 1467395368
Health Care Provider/Practitioner: MARISSA JACOBSON ATC

Information about “1467395368” NPI (MARISSA JACOBSON ATC) exists in 1467395368 in HTML format HTML  |  1467395368 in plain Text format TXT  |  1467395368 in PDF (Portable Document Format) PDF  |  1467395368 in an XML format XML  formats.

NPI Number : 1467395368 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467395368",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACOBSON",
    "FirstName": "MARISSA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7900 LEES SUMMIT RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KANSAS CITY",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64139-1236",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-404-7200",
    "MailingAddressFaxNumber": "816-404-7062",
    "FirstLinePracticeLocationAddress": "7900 LEES SUMMIT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KANSAS CITY",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "64139-1236",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-404-7200",
    "PracticeLocationAddressFaxNumber": "816-404-7062",
    "EnumerationDate": "04/14/2026",
    "LastUpdateDate": "04/14/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "24-01714",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2024002457",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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