National Provider Identifier
Kjersten Lydia McKinniss, ATC
Kjersten Lydia McKinniss, ATC is listed in the NPPES registry with a primary specialty of Athletic Trainer in Ithaca, NY and a listed phone number of (616) 395-7000.
Profile Overview
- NPI
- 1609246123
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- September 26, 2015
- Last Updated
- December 17, 2021
Practice Location
- 310 Taughannock Blvd
- Ithaca, NY 14850-3251
Phone: (616) 395-7000
Specialties
- Athletic Trainer (2255A2300X)
Full Record
- NPI
- 1609246123
- Entity Type
- Individual
- Last Name
- McKinniss
- First Name
- Kjersten
- Middle Name
- Lydia
- Name Prefix
- MS.
- Credential
- ATC
- Mailing Street Address
- 310 Taughannock Blvd
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-3251
- Mailing Country
- US
- Practice Street Address
- 310 Taughannock Blvd
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-3251
- Practice Country
- US
- Practice Phone
- (616) 395-7000
- Enumeration Date
- September 26, 2015
- Last Updated
- December 17, 2021
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- December 17, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X)