MEDICARE: MS. CHRISTINA DANIELLE KELLEY LAT, 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	2165	NC
2	2255A2300X	Athletic Trainer	AT5270	TX

General Provider Information

NPI Number	:	1194146746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA DANIELLE KELLEY LAT, ATC

Provider Business Mailing Address
First Line	:	7912 IRISH DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5738
Country	:	US
Telephone Number	:	817-903-6878
Fax Number	:

Provider Business Practice Location Address
First Line	:	7912 IRISH DR
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5738
Country	:	US
Telephone Number	:	817-903-6878
Fax Number	:

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

Provider Enumeration Date	:	12/29/2013
Last Update Date	:	09/23/2020

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