Healthcare Provider Details

I. General information

NPI: 1215694005
Provider Name (Legal Business Name): BRIANNA LYNN KAUFFMANN LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 9TH AVE SW
FARIBAULT MN
55021-5958
US

IV. Provider business mailing address

601 1ST AVE NE APT 412
FARIBAULT MN
55021-2902
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-6100
  • Fax:
Mailing address:
  • Phone: 320-314-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: