MEDICARE: VALERIE MARIE TINKLEPAUGH-HAIRSTON 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

General Provider Information

NPI Number	:	1407891229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE MARIE TINKLEPAUGH-HAIRSTON ATC, LAT

Provider Business Mailing Address
First Line	:	10905 MIDDLEGLEN RD
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-6173
Country	:	US
Telephone Number	:	817-343-1534
Fax Number	:	817-257-6640

Provider Business Practice Location Address
First Line	:	2900 STADIUM DR
Second Line	:	DMC SPORTS MEDICINE
City	:	FORT WORTH
State	:	TX
Zip	:	76129-0001
Country	:	US
Telephone Number	:	817-257-6647
Fax Number	:	817-257-6640

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/07/2014

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