Healthcare Provider Details

I. General information

NPI: 1720888167
Provider Name (Legal Business Name): JOSEPH KAPIGENO URBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9408 APISON PIKE STE 174
COLLEGE DALE TN
37363-5977
US

IV. Provider business mailing address

10726 LONNIE LN
COLLEGE DALE TN
37363-8522
US

V. Phone/Fax

Practice location:
  • Phone: 423-702-8463
  • Fax:
Mailing address:
  • Phone: 509-655-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1241311704
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: