Kelli Jo Rueckert, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

00277 Issued in IA

Practice address

901 Montgomery St
Decorah, IA 52101-2325

Phone

(563) 387-3031

Fax

(563) 387-3021

NPI assigned

Apr 10, 2006

Last updated

Dec 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelli Blum Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1205899473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80",
            "city": "OSSIAN",
            "state": "IA",
            "postal_code": "521610080",
            "telephone_number": "563-532-8900",
            "fax_number": "563-387-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-387-3031",
            "fax_number": "563-387-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUECKERT",
        "first_name": "KELLI",
        "middle_name": "JO",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "00277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "BLUM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lori Rissman, PHARMD
• Andrew J Rix, MPT, CSCS
• Seth Robinson, LMSW
• Ashley Roney, HCP
• Christine Sue Roth, CRNA
• Anna M. Ryan, MD
• Janet S Ryan, MD
• Bailey Sadler, LMSW
• Matthew Samec, MD
• Kevin L Sand, M.D.

• Athletic Trainer in Decorah, IA
• Providers in Decorah, IA by specialty
• Athletic Trainer in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.