Healthcare Provider Details

I. General information

NPI: 1003773888
Provider Name (Legal Business Name): LORELEI TARA SIMS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POPLAR AVE
COLLIERVILLE TN
38017-0605
US

IV. Provider business mailing address

675 ALLEN RD
WILLISTON TN
38076-3017
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-5491
  • Fax:
Mailing address:
  • Phone: 901-592-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1120
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: