Kyle Jordan Frerking, LAT, ATC
Individual provider Active NPI Athletic Trainer · Maryville, MO
NPI 1700580701 · NPPES record last updated Jul 2, 2024
Key facts
- NPI
- 1700580701
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 800 University Dr
Maryville, MO 64468-6001 - Phone
- (816) 783-7179
- NPI assigned
- Mar 27, 2023
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
800 University Dr
Maryville, MO 64468-6001
Mailing address
116 N Depot St
Maryville, MO 64468-1948
Phone (816) 783-7179
Other providers in Maryville, MO
- Miranda Marie Floyd
- Jack L Forest
- Joshua Wayne Foster
- Fox Ridge Wellness & Rehabilitation LLC
- David A Fox II
- Karen E. From
- Judy D Frueh
- Rosvic Galapin
- Michael Gard
- Jeffry Paul Gardner
All providers in Maryville, 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 Jul 2, 2024. 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.