MEDICARE: JOANNA KEY LAT, 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer	0506596	NV

General Provider Information

NPI Number	:	1255895579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA KEY LAT, ATC

Provider Business Mailing Address
First Line	:	440 W AZURE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1368
Country	:	US
Telephone Number	:	520-440-8298
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 W AZURE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1368
Country	:	US
Telephone Number	:	520-440-8298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	03/03/2021

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Directions to “ JOANNA KEY LAT, ATC” Practice Location

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