Individual
KAITLIN INNISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17017 N 12TH ST UNIT 1003, PHOENIX, AZ 85022-2031
(307) 421-6389
Mailing address
2811 FOOTHILLS RD, CHEYENNE, WY 82009-4536
(307) 421-6389
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATR-009302
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
AZ
Other
Enumeration date
09/12/2019
Last updated
03/26/2022
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