Healthcare Provider Details

I. General information

NPI: 1073021481
Provider Name (Legal Business Name): DAVID LLOYD KENNEDY JR. ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 ELLIOTT DR
MIDLAND CITY AL
36350-4097
US

IV. Provider business mailing address

207 ELLIOTT DR
MIDLAND CITY AL
36350-4097
US

V. Phone/Fax

Practice location:
  • Phone: 860-625-1048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2458
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: