Provider Demographics
NPI:1184198806
Name:WARREN, KELSEY (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N GRAND AVE STE 6A
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-4400
Mailing Address - Country:US
Mailing Address - Phone:386-453-0495
Mailing Address - Fax:
Practice Address - Street 1:900 N GRAND AVE STE 6A
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-4400
Practice Address - Country:US
Practice Address - Phone:903-813-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TXAT84622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer