Healthcare Provider Details

I. General information

NPI: 1073589685
Provider Name (Legal Business Name): KELSEY SHAY MCLEMORE A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 SAINT VINCENTS DR SUITE 415
BIRMINGHAM AL
35205-1684
US

IV. Provider business mailing address

3550 GRANDVIEW PKWY #628
BIRMINGHAM AL
35243-1949
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-3000
  • Fax:
Mailing address:
  • Phone: 205-262-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number803
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: