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General NPI Number Information
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NPI Number | 1194413112
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Entity Type | Individual
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Provider Name | KENNEDY DEWEY-MIGHELL LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 1665 HAMPSHIRE PIKE
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City | COLUMBIA
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State | TN
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Zip | 38401-5653
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Country | US
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Telephone | 815-973-2628
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 GOLDEN CT
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City | SPRING HILL
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State | TN
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Zip | 37174-9602
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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 | 2962
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License Number State | TN
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