Healthcare Provider Details

I. General information

NPI: 1003051566
Provider Name (Legal Business Name): MARK ALLEN CAIRNS A.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 WAKARUSA DR
LAWRENCE KS
66049
US

IV. Provider business mailing address

21062 W 118TH TER
OLATHE KS
66061-5562
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-3444
  • Fax: 785-842-3410
Mailing address:
  • Phone: 785-424-4892
  • Fax: 785-842-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00003
License Number StateKS

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: