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General NPI Number Information
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NPI Number | 1700403532
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Entity Type | Individual
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Provider Name | JORDYN MYSKA
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Gender | Female
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Dates
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Enumeration Date | 06/27/2020
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4310 APPLEBY SAND RD
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2232
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Country | US
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Telephone | 936-564-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 20718 OAK FOREST RD
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City | DAMON
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State | TX
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Zip | 77430-9688
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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 | AT9032
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License Number State | TX
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