Healthcare Provider Details

I. General information

NPI: 1639094501
Provider Name (Legal Business Name): KAIDEN KIRKLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 STADIUM DR.
GLEN ROSE TX
76043
US

IV. Provider business mailing address

9006 N LONGWOOD DR
GRANBURY TX
76049-4709
US

V. Phone/Fax

Practice location:
  • Phone: 325-500-8314
  • Fax: 325-500-8314
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT9799
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: