Healthcare Provider Details

I. General information

NPI: 1699648808
Provider Name (Legal Business Name): KURT TURNER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N 1ST ST
SPRINGFIELD IL
62702-3778
US

IV. Provider business mailing address

208 BELVIEW AVE
NORMAL IL
61761-1310
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: