MEDICARE: MS. LORELEI TARA SIMS ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1120	TN

General Provider Information

NPI Number	:	1003773888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORELEI TARA SIMS ATC, LAT

Provider Business Mailing Address
First Line	:	675 ALLEN RD
Second Line	:
City	:	WILLISTON
State	:	TN
Zip	:	38076-3017
Country	:	US
Telephone Number	:	901-592-9465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-0605
Country	:	US
Telephone Number	:	901-759-5491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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