Healthcare Provider Details

I. General information

NPI: 1558291302
Provider Name (Legal Business Name): MICAH ROWLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 JACANA DR
LEXINGTON KY
40503-1114
US

IV. Provider business mailing address

1546 JACANA DR
LEXINGTON KY
40503-1114
US

V. Phone/Fax

Practice location:
  • Phone: 270-938-3599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: