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General NPI Number Information
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NPI Number | 1689108391
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Entity Type | Individual
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Provider Name | KIMBERLY MCCARTNEY LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 1311 FLORIDA AVE BLDG 36087
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City | TYNDALL AFB
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State | FL
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Zip | 32403-5207
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Country | US
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Telephone | 210-383-5091
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Fax |
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Provider Business Mailing Address
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Address Line | 3005 HAWTHORNE PL
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City | LYNN HAVEN
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State | FL
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Zip | 32444-5652
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Country | US
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Telephone | 210-383-5091
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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 | AT6390
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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 | AL5838
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License Number State | FL
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