Healthcare Provider Details

I. General information

NPI: 1689329211
Provider Name (Legal Business Name): MISS VICTORIA LYNN YORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 UNION UNIVERSITY DR # UU2246
JACKSON TN
38305-3656
US

IV. Provider business mailing address

67 TURNER RD
RAMER TN
38367-6260
US

V. Phone/Fax

Practice location:
  • Phone: 731-439-5310
  • Fax:
Mailing address:
  • Phone: 731-439-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: