Healthcare Provider Details

I. General information

NPI: 1083548507
Provider Name (Legal Business Name): KYREN HENNING ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W SUPERIOR ST
ALMA MI
48801-1504
US

IV. Provider business mailing address

141 W HIGH ST
OVID MI
48866-9747
US

V. Phone/Fax

Practice location:
  • Phone: 989-413-2630
  • Fax:
Mailing address:
  • Phone: 989-413-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: