Kyle Jordan Frerking, LAT, ATC
Specialist/Technologist, Athletic Trainer in Maryville, MO. Individual provider (NPI-1).
NPI number1700580701
StatusActive
Last updated in NPPESJul 2, 2024
Details
- NPI
- 1700580701
- Entity type
- Individual (NPI-1)
- Name
- Kyle Jordan Frerking
- Credential
- LAT, ATC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 27, 2023
- Certification date
- Jul 2, 2024
- Last updated
- Jul 2, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – | Yes |
Practice location
800 University DrMaryville, MO 64468-6001
Phone 816-783-7179
Mailing address
116 N Depot StMaryville, MO 64468-1948
Phone 816-783-7179
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