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General NPI Number Information
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NPI Number | 1912631763
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Entity Type | Individual
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Provider Name | KELSEY JOAN EVINS ATC
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 121 N DIVISION ST STE 310
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City | AUBURN
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State | WA
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Zip | 98001-4931
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Country | US
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Telephone | 253-545-5978
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 OFARRELL LN NW
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City | ORTING
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State | WA
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Zip | 98360-7418
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Country | US
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Telephone | 541-379-1825
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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 | A160969833
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License Number State | WA
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