Healthcare Provider Details

I. General information

NPI: 1457890980
Provider Name (Legal Business Name): BRANDON KRON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CAVALIER BLVD 1700
FLORENCE KY
41042-1645
US

IV. Provider business mailing address

68 CAVALIER BLVD 1700
FLORENCE KY
41042-1645
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-0707
  • Fax: 859-647-3022
Mailing address:
  • Phone: 859-283-0707
  • Fax: 859-647-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT857
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: