Individual
JENNIFER NICOLE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT
Contact information
Practice address
520 LIZZIE PL E, WEST FARGO, ND 58078-8500
(701) 490-1434
Mailing address
520 LIZZIE PLACE EAST, WEST FARGO, ND 58078
(701) 490-1434
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
50447
ND
Other
Enumeration date
12/19/2014
Last updated
12/19/2014
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