Provider Demographics
NPI:1770041428
Name:HERRING, KAILYN OVERCASH (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KAILYN
Middle Name:OVERCASH
Last Name:HERRING
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MS
Other - First Name:KAILYN
Other - Middle Name:BROOKE
Other - Last Name:OVERCASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:505 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9298
Mailing Address - Country:US
Mailing Address - Phone:704-260-6570
Mailing Address - Fax:
Practice Address - Street 1:505 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-9298
Practice Address - Country:US
Practice Address - Phone:704-260-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-29482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer