Healthcare Provider Details

I. General information

NPI: 1780178152
Provider Name (Legal Business Name): ABIGAIL DAWN HEMPEL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 N MAIN ST
MOUNTAIN GROVE MO
65711
US

IV. Provider business mailing address

234 E 9TH ST
MOUNTAIN GROVE MO
65711-1157
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-5699
  • Fax:
Mailing address:
  • Phone: 417-379-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: