Individual
KEVIN KYLE COLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W UNIVERSITY AVE, HAMMOND, LA 70401-1304
(985) 549-2000
Mailing address
125 STUART DR, VIDALIA, LA 71373-3705
(601) 807-9485
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7770002842946401
—
LA
Enumeration date
02/04/2019
Last updated
02/04/2019
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