Healthcare Provider Details

I. General information

NPI: 1679122998
Provider Name (Legal Business Name): BAYLEE NICOLE KIMBRELL LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 DAUPHIN STREET
MOBILE AL
36688-3988
US

IV. Provider business mailing address

1018 CLIFTON ST APT 7
CONWAY AR
72034-3988
US

V. Phone/Fax

Practice location:
  • Phone: 251-380-3493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2396
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: