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NPI Code Detail

MEDICARE: KATHERINE MEGAN BYNUM ATC

MEDICARE: KATHERINE MEGAN BYNUM ATC
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
12255A2300XAthletic Trainer1655TN

General Provider Information

NPI Number : 1013467620
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MEGAN BYNUM ATC
Provider Business Mailing Address
First Line : 1 CUMBERLAND SQ
Second Line :
City : LEBANON
State : TN
Zip : 37087-3408
Country : US
Telephone Number : 615-547-1306
Fax Number :
Provider Business Practice Location Address
First Line : 1 CUMBERLAND SQ
Second Line :
City : LEBANON
State : TN
Zip : 37087-3408
Country : US
Telephone Number : 615-547-1306
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2016
Last Update Date : 10/06/2016

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