Individual
KELLI JEAN PENROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A., ATC
Contact information
Practice address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 259-4100
(320) 259-8044
Mailing address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 259-4100
(320) 259-8044
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
MN
363A00000X
Physician Assistant
Primary
—
MN
Other
Enumeration date
11/20/2008
Last updated
05/20/2020
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