Provider Demographics
NPI:1386227510
Name:TIMMONS, KELSEY LAUREN (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:LAUREN
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LAUREN
Other - Last Name:TIMMONS-MONRREAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2208 BAUGH RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4115
Mailing Address - Country:US
Mailing Address - Phone:303-489-8465
Mailing Address - Fax:
Practice Address - Street 1:13212 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1010
Practice Address - Country:US
Practice Address - Phone:512-594-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT80372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2000022606OtherATHLETIC TRAINER CERTIFIED