MEDICARE: KENDRA KAY MESSER M.S., ATC, LAT

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	36002261A	IN

General Provider Information

NPI Number	:	1053729244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA KAY MESSER M.S., ATC, LAT

Provider Business Mailing Address
First Line	:	6318 CORNWALLIS DR APT 2A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-8365
Country	:	US
Telephone Number	:	317-442-1026
Fax Number	:

Provider Business Practice Location Address
First Line	:	6318 CORNWALLIS DR. APT 2A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-8365
Country	:	US
Telephone Number	:	317-442-1026
Fax Number	:

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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