Individual
KENDALL NICOLE MIKKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
19790 ASHBURN RD, ASHBURN, VA 20147-5636
(571) 209-5500
Mailing address
11795 ANTIETAM RD, WOODBRIDGE, VA 22192-1214
(210) 422-6811
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/03/2023
Last updated
08/18/2023
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