Gabrielle Herod
Individual provider Active NPI Athletic Trainer · Black Jack, MO
NPI 1699355404 · NPPES record last updated Apr 14, 2021
Key facts
- NPI
- 1699355404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 5270 Springtrail Dr
Black Jack, MO 63033-4417 - Phone
- (314) 412-0545
- NPI assigned
- Apr 14, 2021
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
5270 Springtrail Dr
Black Jack, MO 63033-4417
Mailing address
5270 Springtrail Dr
Black Jack, MO 63033-4417
Phone (314) 412-0545
Other providers in Black Jack, MO
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- Mondrakus Harper
- Laquita Larai Harris
- Homestead Health Care IHS LLC
- Homestead Health Care LLC
- Marilyn Hubbard
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- J & S Complete Health Care IHS LLC
All providers in Black Jack, MO · Athletic Trainer in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 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.