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General NPI Number Information
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NPI Number | 1497239834
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Entity Type | Individual
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Provider Name | KRISHA KACKLEY
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 10790 NALL AVE
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1206
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Country | US
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Telephone | 316-300-1047
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Fax |
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Provider Business Mailing Address
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Address Line | 10242 W 80TH ST APT 213
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City | OVERLAND PARK
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State | KS
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Zip | 66204-4706
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Country | US
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Telephone | 316-300-1047
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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 | 24-01240
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License Number State | KS
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