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General NPI Number Information
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NPI Number | 1538119383
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Entity Type | Individual
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Provider Name | KEVIN M BROWN ATC
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 12935 SHELBYVILLE RD SUITE 106
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City | LOUISVILLE
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State | KY
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Zip | 40243-1592
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Country | US
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Telephone | 502-489-5002
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Fax | 502-489-8002
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Provider Business Mailing Address
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Address Line | 214 MIDDLETOWN SQ
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City | LOUISVILLE
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State | KY
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Zip | 40243-1462
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Country | US
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Telephone | 502-994-0709
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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 | AT672
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License Number State | KY
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