Individual
MS. KJERSTEN LYDIA MCKINNISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
310 TAUGHANNOCK BLVD, ITHACA, NY 14850-3251
(616) 395-7000
Mailing address
310 TAUGHANNOCK BLVD, ITHACA, NY 14850-3251
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003601
NY
Other
Enumeration date
09/26/2015
Last updated
12/17/2021
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