Individual
KELSEY JACKSON FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
2005 MILLER ST, CLOVIS, NM 88101-8660
(505) 269-5962
Mailing address
2005 MILLER ST, CLOVIS, NM 88101-8660
(505) 269-5962
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT656
NM
Other
Enumeration date
01/06/2022
Last updated
01/06/2022
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