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General NPI Number Information
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NPI Number | 1043962681
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Entity Type | Individual
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Provider Name | KIRSTEN ARIELLE HUNDERTMARK MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 4100 BRONCO LN
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City | ZACHARY
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State | LA
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Zip | 70791-3024
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Country | US
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Telephone | 225-654-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 OLDE OAKS DR
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City | ZACHARY
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State | LA
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Zip | 70791-7030
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Country | US
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Telephone | 401-965-2012
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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 | 310284
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT00385
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License Number State | RI
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