Individual provider · NPI-1

Kevin Hansen

Specialist/Technologist, Athletic Trainer · Jackson, TN

NPI number1194340430
StatusActive
Last updated in NPPESJun 12, 2020

Details

NPI
1194340430
Entity type
Individual (NPI-1)
Name
Kevin Hansen
Sex
Male
Sole proprietor
No
Enumeration date
Jun 12, 2020
Certification date
Jun 12, 2020
Last updated
Jun 12, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer1479TNYes

Practice location

1378 Union University Dr
Jackson, TN 38305-3780

Phone 731-664-7060 · Fax 731-664-5005

Mailing address

1804 Highway 45 Byp Ste 604
Jackson, TN 38305-4403

Phone 731-660-8781 · Fax 731-660-8739

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