Kenneth Lassiter, MS, ATC, LAT
Specialist/Technologist, Athletic Trainer in Fayetteville, NC. Individual provider (NPI-1).
NPI number1770180903
StatusActive
Last updated in NPPESDec 23, 2021
Details
- NPI
- 1770180903
- Entity type
- Individual (NPI-1)
- Name
- Kenneth Lassiter
- Credential
- MS, ATC, LAT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 1, 2020
- Certification date
- Aug 2, 2021
- Last updated
- Dec 23, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 20000190028 | NC | Yes |
Practice location
1200 Murchison RdFayetteville, NC 28301-4252
Phone 336-953-0668
Mailing address
6528 Tampico CtFayetteville, NC 28303-2334
Phone 336-953-0668
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