Individual
MR. KEVIN DEE MANGUM I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC LAT
Contact information
Practice address
5800 AIRLINE DR, METAIRIE, LA 70003-3876
(504) 733-0255
(504) 731-1805
Mailing address
5325 COCOS PLUMOSAS DR, KENNER, LA 70065-2320
(504) 885-9111
(504) 731-1805
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.J00034
LA
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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