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General NPI Number Information
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NPI Number | 1417206129
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Entity Type | Individual
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Provider Name | KELSI HUSEMAN ATC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 800 UNIVERSITY DR
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City | MARYVILLE
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State | MO
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Zip | 64468-6015
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Country | US
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Telephone | 712-542-9053
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Fax |
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Provider Business Mailing Address
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Address Line | 2090 TOLBERT AVE
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City | CLARINDA
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State | IA
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Zip | 51632-4060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0011069
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 607
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License Number State | NE
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