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NPI Code Detail

MEDICARE: MS. KELLY LYNN BACHUS MED, ATC

MEDICARE: MS. KELLY LYNN BACHUS MED, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer1155TN
22255A2300XAthletic TrainerAT0360MS

General Provider Information

NPI Number : 1013088558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY LYNN BACHUS MED, ATC
Provider Business Mailing Address
First Line : 6633 GETTYSBURG DR
Second Line :
City : MADISON
State : WI
Zip : 53705-4206
Country : US
Telephone Number : 512-297-0277
Fax Number :
Provider Business Practice Location Address
First Line : 500 LINCOLN DR
Second Line :
City : MADISON
State : WI
Zip : 53706-1314
Country : US
Telephone Number : 608-515-3893
Fax Number : 608-265-4736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/21/2022

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