Healthcare Provider Details

I. General information

NPI: 1285099390
Provider Name (Legal Business Name): ASHLEY CARROLL YELMINI MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 HUMIE OLIVE RD
APEX NC
27502-9627
US

IV. Provider business mailing address

110 GALLENT HEDGE TRL
APEX NC
27539-6506
US

V. Phone/Fax

Practice location:
  • Phone: 919-694-0500
  • Fax:
Mailing address:
  • Phone: 919-607-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2141
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: