Provider Demographics
NPI:1457887069
Name:FONT, KYNDALL NICHOLLE (LAT, ATC, NASM-CES)
Entity Type:Individual
Prefix:MRS
First Name:KYNDALL
Middle Name:NICHOLLE
Last Name:FONT
Suffix:
Gender:F
Credentials:LAT, ATC, NASM-CES
Other - Prefix:MISS
Other - First Name:KYNDALL
Other - Middle Name:NICHOLLE
Other - Last Name:FREER-CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC, NASM-CES
Mailing Address - Street 1:111 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4747
Mailing Address - Country:US
Mailing Address - Phone:817-707-6335
Mailing Address - Fax:
Practice Address - Street 1:3001 W HIGHWAY 287 BYP
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-5009
Practice Address - Country:US
Practice Address - Phone:972-923-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
TXAT72412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT7241OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
2000027874OtherNATIONAL ATHLETIC TRAINER'S BOARD OF CERTIFICATION