Healthcare Provider Details

I. General information

NPI: 1750864625
Provider Name (Legal Business Name): ABIGAIL ELISE LIPPERT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3932 INDIANA AVE
FORT CAMPBELL KY
42223-5931
US

IV. Provider business mailing address

656 DEER RIDGE DR
CLARKSVILLE TN
37042-7064
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-9418
  • Fax:
Mailing address:
  • Phone: 678-773-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3274
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: