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General NPI Number Information
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NPI Number | 1215330964
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Entity Type | Individual
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Provider Name | KATE HENLEY M.S., A.T.C., C.E.S.
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Gender | Female
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 3955 SWENSON ST APT 90
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City | LAS VEGAS
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State | NV
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Zip | 89119-7237
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Country | US
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Telephone | 267-269-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 3955 SWENSON ST APT 90
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City | LAS VEGAS
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State | NV
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Zip | 89119-7237
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Country | US
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Telephone | 267-269-0044
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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 | AT002395
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License Number State | GA
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