MEDICARE: KYLE TIGNER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1285901835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE TIGNER ATC

Provider Business Mailing Address
First Line	:	21083 HARBOR LN UNIT A
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-8400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21083 HARBOR LN UNIT A
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-8400
Country	:	US
Telephone Number	:	231-750-2873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	02/14/2019

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Directions to “ KYLE TIGNER ATC” Practice Location

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