Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KEVIN WALLACE, ATC
Active Sole ProprietorKEVIN WALLACE, ATC is a Athletic Trainer healthcare provider located in DECHARD, Tennessee. NPI 1265100184 is currently active in the NPPES registry. Verify at CMS.
Athletic Trainer · DECHARD, TN
Registration Details
- NPI Number
- 1265100184
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 3, 2021 (4.9522250450218 yrs)
- Last Updated
- Sep 3, 2021
- License
-
0000000293 (TN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
100 BIBLE CROSSING RDDECHARD, TN, 37324Browse TN providers · Browse ZIP 37324
- Phone
- 9319629947
- Primary Specialty
-
Athletic Trainer
2255A2300X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.