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General NPI Number Information
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NPI Number | 1811306459
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Entity Type | Individual
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Provider Name | BRIANNA NELSON ATC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 1 COLLEGE PARK DR
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8660
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Country | US
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Telephone | 314-485-8415
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Fax |
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Provider Business Mailing Address
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Address Line | 122 STEAMBOAT LN #302
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City | BALLWIN
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State | MO
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Zip | 63011-3202
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Country | US
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Telephone | 845-750-1933
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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 | 2014024990
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License Number State | MO
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