MEDICARE: MR. KASHAWN NELSON FRASER

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

General Provider Information

NPI Number	:	1588131445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KASHAWN NELSON FRASER

Provider Business Mailing Address
First Line	:	606 ANDERSON CIR APT 202
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-7738
Country	:	US
Telephone Number	:	833-233-5348
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 ANDERSON CIR APT 202
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-7738
Country	:	US
Telephone Number	:	833-233-5348
Fax Number	:

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	06/11/2019

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