Healthcare Provider Details

I. General information

NPI: 1801389986
Provider Name (Legal Business Name): ASHLEY MICHELLE JAMES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 SW RAINTREE DR
LEES SUMMIT MO
64082-4606
US

IV. Provider business mailing address

414 E PORTE CIMI PAS ST
KANSAS CITY MO
64131-2922
US

V. Phone/Fax

Practice location:
  • Phone: 708-491-9073
  • Fax:
Mailing address:
  • Phone: 708-491-9073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2022031290
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01520
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: