Healthcare Provider Details

I. General information

NPI: 1619889664
Provider Name (Legal Business Name): FERNANDO HERNANDEZ MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COIT RD
PLANO TX
75075-5811
US

IV. Provider business mailing address

1209 S KENTUCKY ST
MCKINNEY TX
75069-5339
US

V. Phone/Fax

Practice location:
  • Phone: 469-229-5160
  • Fax:
Mailing address:
  • Phone: 214-385-9832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT9598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: