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NPI Code Detail

MEDICARE: KEVIN KYLE COLEY JR.

MEDICARE: KEVIN KYLE COLEY JR.
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
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic Trainer

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306301338
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN KYLE COLEY JR.
Provider Business Mailing Address
First Line : 125 STUART DR
Second Line :
City : VIDALIA
State : LA
Zip : 71373-3705
Country : US
Telephone Number : 601-807-9485
Fax Number :
Provider Business Practice Location Address
First Line : 500 W UNIVERSITY AVE
Second Line :
City : HAMMOND
State : LA
Zip : 70401-1304
Country : US
Telephone Number : 985-549-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2019
Last Update Date : 02/04/2019

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