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General NPI Number Information
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NPI Number | 1932823747
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Entity Type | Individual
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Provider Name | CARA BREANNE JAY ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 07/16/2023
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Provider Practice Location Address
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Address Line | 1004 PROGRESS DR STE 180
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City | LANSING
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State | KS
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Zip | 66043-6323
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Country | US
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Telephone | 913-297-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 528 MERCHANT ST APT 204
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City | EMPORIA
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State | KS
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Zip | 66801-4172
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Country | US
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Telephone | 913-706-8744
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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 |
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License Number State | KS
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