MEDICARE: KRYSTAL LYNN ROBERTSON 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	2015035641	MO

General Provider Information

NPI Number	:	1770449225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL LYNN ROBERTSON ATC

Provider Business Mailing Address
First Line	:	186 ECHO VALLEY CIR
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-8984
Country	:	US
Telephone Number	:	417-880-2589
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 CAHILL RD
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-2036
Country	:	US
Telephone Number	:	417-348-8100
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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