Jordin Ashlee Brouhard, ATC
Individual provider Active NPI Athletic Trainer · Shawnee, KS
NPI 1073157699 · NPPES record last updated Nov 6, 2019
Key facts
- NPI
- 1073157699
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 24-01036 (KS)
- Practice address
- 13847 W 63Rd St Ste 2
Shawnee, KS 66216-3800 - Phone
- (913) 962-7770
- Fax
- (913) 962-7775
- NPI assigned
- Nov 6, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-01036 | KS | MD | Athletic Trainer |
| 2019032147 | MO | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2019032147 | MO | |
| Athletic Trainer | 2255A2300X | 24-01036 | KS | Yes |
Addresses
Primary practice location
13847 W 63Rd St Ste 2
Shawnee, KS 66216-3800
Mailing address
6397 Lee Hwy Ste 300
Chattanooga, TN 37421-4915
Phone (423) 238-7217
Other providers in Shawnee, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.