Kristen Brown
Individual provider Active NPI Athletic Trainer · Plymouth, IN
NPI 1629643580 · NPPES record last updated May 24, 2021
Key facts
- NPI
- 1629643580
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 4160100164 (IN)
- Practice address
- 14260 Lawrence Lake Dr
Plymouth, IN 46563-8573 - Phone
- (574) 933-2913
- NPI assigned
- May 24, 2021
- 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 |
|---|---|---|---|
| 4160100164 | IN | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 4160100164 | IN | Yes |
Addresses
Primary practice location
14260 Lawrence Lake Dr
Plymouth, IN 46563-8573
Mailing address
14260 Lawrence Lake Dr
Plymouth, IN 46563-8573
Phone (574) 933-2913
Other providers in Plymouth, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2021. 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.