Individual
KYLEIGH GRACE GENCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19239 LORANGER TRCE, LORANGER, LA 70446-2303
(985) 351-0466
Mailing address
19239 LORANGER TRCE, LORANGER, LA 70446-2303
(985) 351-0466
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/21/2019
Last updated
02/21/2019
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