Kristen Cornett
Individual provider Active NPI Athletic Trainer · Fort Drum, NY
NPI 1508475211 · NPPES record last updated Aug 10, 2022
Key facts
- NPI
- 1508475211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT.0002144 (CO)
- Practice address
- 20460 Anaconda Rd
Fort Drum, NY 13603 - Phone
- (719) 428-9621
- NPI assigned
- Jul 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| AT.0002144 | CO | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT.0002144 | CO | Yes |
Addresses
Primary practice location
20460 Anaconda Rd
Fort Drum, NY 13603
Mailing address
9646D Butler Loop
Fort Drum, NY 13603-3217
Other providers in Fort Drum, NY
- Zachary Rosello Collins
- Yolanda Kaye Colon
- James Maxwell Contessa
- Janelle Lynn Cordova
- Andrew David Cornelison
- Jeffrey Morgan Cox
- Linda Cox
- David Bruce Crandall Jr.
- Edan Critchfield
- Steven Colton Crowther
All providers in Fort Drum, NY · Athletic Trainer in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2022. 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.