MEDICARE: ASHLEY MICK

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1316673965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MICK

Provider Business Mailing Address
First Line	:	11200 DELAWARE PKWY APT 1319
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-3742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11200 DELAWARE PKWY APT 1319
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-3742
Country	:	US
Telephone Number	:	816-783-0001
Fax Number	:

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

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	05/13/2024

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Directions to “ ASHLEY MICK ” Practice Location

Language	Start Address	Practice Location

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