Individual provider · NPI-1

Kelly J Burns, ATC

Specialist/Technologist, Athletic Trainer · Fargo, ND

NPI number1164577482
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1164577482
Entity type
Individual (NPI-1)
Name
Mr. Kelly J Burns
Credential
ATC
Sex
Male
Sole proprietor
No
Enumeration date
Jan 25, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer047-87NDYes

Practice location

2301 25th St S
Fargo, ND 58103-6104

Phone 701-280-2406

Mailing address

3928 3rd St S
Moorhead, MN 56560-5602

Phone 218-236-9913

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