Healthcare Provider Details

I. General information

NPI: 1003371527
Provider Name (Legal Business Name): REAGAN CLAIRE SKIDMORE LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GALLOWAY DRIVE
HAMMOND LA
70402-3339
US

IV. Provider business mailing address

17017 CULPS BLUFF AVE
BATON ROUGE LA
70817-3339
US

V. Phone/Fax

Practice location:
  • Phone: 985-549-5133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number323947
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: