=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619325263
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN MEYERS MS, ATC, LAT, CSCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2016
-----------------------------------------------------
Last Update Date | 05/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1614 LATOURETTE LN APT 2
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-871-9179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 491
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72364-0491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-871-9179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 617
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------