Provider Demographics
NPI:1487035556
Name:HOOD, KELLY BARNES (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BARNES
Last Name:HOOD
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 INDIGO ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-4849
Mailing Address - Country:US
Mailing Address - Phone:919-815-5687
Mailing Address - Fax:
Practice Address - Street 1:A-1682 LONGSTREET ROAD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-2335
Practice Address - Country:US
Practice Address - Phone:910-396-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-07-27
Deactivation Date:2022-01-23
Deactivation Code:
Reactivation Date:2022-04-08
Provider Licenses
StateLicense IDTaxonomies
NCLAT-28812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer