Individual
NICOLE LYNN BALDERSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
1950 DIAMOND PKWY, KANSAS CITY, MO 64116-4328
(816) 561-3003
Mailing address
5625 W 134TH PL APT 2037, OVERLAND PARK, KS 66209-4064
(785) 819-1129
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2019032463
MO
2255A2300X
Athletic Trainer
Primary
24-01454
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000015152
NATA BOC
—
01
—
2019032463
AT LINCENSE
MO
01
—
24-01454
AT LICENSE
KS
Enumeration date
02/06/2023
Last updated
02/06/2023
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