Healthcare Provider Details

I. General information

NPI: 1225965148
Provider Name (Legal Business Name): KIMBERLY ANN NORTON LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E MOREHEAD ST STE 150
CHARLOTTE NC
28202-2782
US

IV. Provider business mailing address

831 E MOREHEAD ST STE 150
CHARLOTTE NC
28202-2782
US

V. Phone/Fax

Practice location:
  • Phone: 704-449-5658
  • Fax:
Mailing address:
  • Phone: 704-449-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: