Garrett Kizzia, ATC
Individual provider Active NPI Athletic Trainer · Warner, OK
NPI 1669014494 · NPPES record last updated Oct 14, 2019
Key facts
- NPI
- 1669014494
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 866 (OK)
- Practice address
- 700 College Rd
Warner, OK 74469-2204 - Phone
- (918) 463-6261
- NPI assigned
- Oct 14, 2019
- Sex
- Male
- 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 |
|---|---|---|---|
| 866 | OK | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 866 | OK | Yes |
Addresses
Primary practice location
700 College Rd
Warner, OK 74469-2204
Mailing address
PO Box 25
Braggs, OK 74423
Phone (580) 235-6364
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 866 | Other | OK | MEDICAL LICENSE NUMBER |
Other providers in Warner, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 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.