Individual
NICHOLAS PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, AT, M.ED
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(989) 225-2274
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(989) 225-2274
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2601001929
MI
2255A2300X
Athletic Trainer
Primary
319272
TN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/02/2016
Last updated
12/27/2023
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