Healthcare Provider Details

I. General information

NPI: 1700626124
Provider Name (Legal Business Name): ASHLEE ROSE KELLY MSAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 STANGE RD STE 102
AMES IA
50010-3965
US

IV. Provider business mailing address

339 BRIDGE ST
BOONE IA
50036-7393
US

V. Phone/Fax

Practice location:
  • Phone: 815-508-5525
  • Fax:
Mailing address:
  • Phone: 815-508-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number139488
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: