Healthcare Provider Details

I. General information

NPI: 1497491963
Provider Name (Legal Business Name): LINDSEY EVAN KENT (WALKER) ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY EVAN KENT ATC

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 2ND AVE SW
CULLMAN AL
35055-4222
US

IV. Provider business mailing address

420 COUNTY ROAD 834
LOGAN AL
35098-1543
US

V. Phone/Fax

Practice location:
  • Phone: 256-775-3737
  • Fax:
Mailing address:
  • Phone: 256-736-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1484
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: