MEDICARE: MISS JESSICA RENEE CATES MED. , ATC, CSCS

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	AT6253	TX

General Provider Information

NPI Number	:	1942576392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA RENEE CATES MED. , ATC, CSCS

Provider Business Mailing Address
First Line	:	1317 ALSTON AVE APT 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4653
Country	:	US
Telephone Number	:	405-606-9915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 ALSTON AVE APT 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4653
Country	:	US
Telephone Number	:	405-606-9915
Fax Number	:

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

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	01/21/2021

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