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General NPI Number Information
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NPI Number | 1447867403
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Entity Type | Individual
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Provider Name | HAYLEY LUCERO MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3280 MITCHELL BLVD
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City | MOODY AFB
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State | GA
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Zip | 31699-3723
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Country | US
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Telephone | 229-257-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 3280 MITCHELL BLVD
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City | MOODY AFB
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State | GA
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Zip | 31699-4507
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Country | US
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Telephone | 505-225-9690
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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 | AT8783
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License Number State | TX
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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 | AT004575
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License Number State | GA
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