Healthcare Provider Details

I. General information

NPI: 1013799618
Provider Name (Legal Business Name): KYLIE BRINKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 RICHLAND AVE
ATHENS OH
45701-2745
US

IV. Provider business mailing address

53 RICHLAND AVE
ATHENS OH
45701-2745
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-9497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: