Healthcare Provider Details

I. General information

NPI: 1770449225
Provider Name (Legal Business Name): KRYSTAL LYNN ROBERTSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CAHILL RD
BRANSON MO
65616-2036
US

IV. Provider business mailing address

186 ECHO VALLEY CIR
REEDS SPRING MO
65737-8984
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8100
  • Fax:
Mailing address:
  • Phone: 417-880-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2015035641
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: