Healthcare Provider Details

I. General information

NPI: 1568425213
Provider Name (Legal Business Name): KEVIN M WOLF ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 CROSSING CIRCLE
MT. JULIET TN
37122
US

IV. Provider business mailing address

1527 SHAGBARK TRL
MURFREESBORO TN
37130-1133
US

V. Phone/Fax

Practice location:
  • Phone: 615-553-5000
  • Fax: 615-553-5001
Mailing address:
  • Phone: 615-848-0275
  • Fax: 615-553-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0000018433
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0000000116
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: