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General NPI Number Information
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NPI Number | 1063809721
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Entity Type | Individual
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Provider Name | KYLE HICKEY ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 1414 UNIVERSITY BLVD
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 937-520-1786
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Fax |
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Provider Business Mailing Address
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Address Line | 5741 OSUNA RD NE APT 815
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2567
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Country | US
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Telephone |
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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 | 583
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License Number State | NM
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