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General NPI Number Information
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NPI Number | 1144112780
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Entity Type | Individual
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Provider Name | KYLER SCOTT WILKERSON MATRN, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1250 SISKIYOU BLVD
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City | ASHLAND
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State | OR
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Zip | 97520-5001
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Country | US
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Telephone | 541-552-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 HEMPSTEAD ST APT 8
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City | MEDFORD
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State | OR
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Zip | 97501-0258
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Country | US
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Telephone | 541-279-7974
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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 | AT-AT-10258306
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License Number State | OR
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