MEDICARE: KAYLA TRAVIS LAT, 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
1	2255A2300X	Athletic Trainer	LAT-5489	NC

General Provider Information

NPI Number	:	1043919657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA TRAVIS LAT, ATC

Provider Business Mailing Address
First Line	:	4621 DUNCASTLE RD APT 1F
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-1654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2298 LONGSTREET RD A
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-396-2792
Fax Number	:

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

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	10/01/2025

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