Provider Demographics
NPI:1932823747
Name:JAY, CARA BREANNE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:BREANNE
Last Name:JAY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 MERCHANT ST APT 204
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-4172
Mailing Address - Country:US
Mailing Address - Phone:913-706-8744
Mailing Address - Fax:
Practice Address - Street 1:1004 PROGRESS DR STE 180
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6323
Practice Address - Country:US
Practice Address - Phone:913-297-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer