Healthcare Provider Details

I. General information

NPI: 1548839897
Provider Name (Legal Business Name): CAROLINE NINI MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BRONCO LN
ZACHARY LA
70791-3024
US

IV. Provider business mailing address

8138 ROCKY TRAIL AVE
BATON ROUGE LA
70820-2925
US

V. Phone/Fax

Practice location:
  • Phone: 985-518-4227
  • Fax:
Mailing address:
  • Phone: 985-518-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number336789
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: