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General NPI Number Information
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NPI Number | 1477110120
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Entity Type | Individual
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Provider Name | KRISTY LEIGH KYSER LAT, MHS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 3506 21ST ST STE 507
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City | LUBBOCK
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State | TX
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Zip | 79410-1233
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Country | US
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Telephone | 806-725-4802
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Fax | 806-723-7790
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Provider Business Mailing Address
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Address Line | 626 N 9TH ST
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City | WOLFFORTH
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State | TX
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Zip | 79382-3326
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Country | US
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Telephone | 512-970-3893
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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 | AT5601
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License Number State | TX
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