Healthcare Provider Details

I. General information

NPI: 1598251266
Provider Name (Legal Business Name): KYLA RAYE EBY ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLA RAYE STANCY

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-8355
US

IV. Provider business mailing address

3129 BROOK HILL DR
CLARKSVILLE TN
37042-8666
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8400
  • Fax:
Mailing address:
  • Phone: 847-529-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2289
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2808
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.003818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: