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NPI Code Detail

MEDICARE: MS. KAREN DONNA STUART FALLIS ATC

MEDICARE: MS. KAREN DONNA STUART FALLIS 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 TrainerLAT-3045NC
22255A2300XAthletic Trainer24-01007KS
32255A2300XAthletic TrainerAL5567FL

General Provider Information

NPI Number : 1023470986
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KAREN DONNA STUART FALLIS ATC
Provider Business Mailing Address
First Line : 2840 COMPASS CT APT 308B
Second Line :
City : FORT BRAGG
State : NC
Zip : 28307-2193
Country : US
Telephone Number : 850-590-1301
Fax Number :
Provider Business Practice Location Address
First Line : 2817 REILLY ST
Second Line :
City : FORT BRAGG
State : NC
Zip : 28310-6723
Country : US
Telephone Number : 850-590-1301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2016
Last Update Date : 08/16/2022

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