Healthcare Provider Details

I. General information

NPI: 1043756463
Provider Name (Legal Business Name): KERRYN ELIZABETH OPAT MED, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E EUCLID ST
MCPHERSON KS
67460-3847
US

IV. Provider business mailing address

1600 E EUCLID ST
MCPHERSON KS
67460-3847
US

V. Phone/Fax

Practice location:
  • Phone: 620-242-0584
  • Fax: 620-242-0515
Mailing address:
  • Phone: 620-242-0584
  • Fax: 620-242-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00899
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: