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General NPI Number Information
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NPI Number | 1013612662
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Entity Type | Individual
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Provider Name | JESSICA L LYLE LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 900 N GRAND AVE # 6A
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City | SHERMAN
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State | TX
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Zip | 75090-4440
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Country | US
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Telephone | 903-813-2514
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1142
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City | VAN ALSTYNE
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State | TX
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Zip | 75495-1142
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Country | US
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Telephone | 540-679-0312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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