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Individual

KELLY MICHELE KRIVULKA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
5850 E STILL CIR, MESA, AZ 85206-3618
(480) 219-6000
Mailing address
544 DAIRY WAY, BUELLTON, CA 93427-9302
(805) 245-5419

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2000034465
BOC
01
93650
NATIONAL ATHLETIC TRAINERS' ASSOCIATION
CA
Enumeration date
02/26/2018
Last updated
05/01/2019
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