MEDICARE: MRS. JENNIFER JOY HARDIN HUSEMAN 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	AT.0001164	CO
2	2255A2300X	Athletic Trainer	1999135153	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1999135153	OTHER	MO	MISSOURI DIVISION OF PROFESSIONAL REGISTRATION
2	AT.0001164	OTHER	CO	COLORADO DEPARTMENT OF REGULATORY AGENCIES

General Provider Information

NPI Number	:	1225097959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JOY HARDIN HUSEMAN ATC

Provider Business Mailing Address
First Line	:	PO BOX 173362
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80217-3362
Country	:	US
Telephone Number	:	417-770-4017
Fax Number	:	303-556-8301

Provider Business Practice Location Address
First Line	:	1201 5TH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-2005
Country	:	US
Telephone Number	:	303-615-1328
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	04/21/2020

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