MEDICARE: TOMMI HERNANDEZ

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		KY

General Provider Information

NPI Number	:	1558291393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMI HERNANDEZ

Provider Business Mailing Address
First Line	:	4844 BRENDA DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 S LIMESTONE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	502-601-2721
Fax Number	:

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ TOMMI HERNANDEZ ” Practice Location

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