MEDICARE: MRS. KRISTEN GITCHEL ATC, LAT

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	120	WY

General Provider Information

NPI Number	:	1902438690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN GITCHEL ATC, LAT

Provider Business Mailing Address
First Line	:	904 7TH ST
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5310
Country	:	US
Telephone Number	:	307-851-1967
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5802
Country	:	US
Telephone Number	:	307-382-1600
Fax Number	:

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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