NPI 1417362559

Russell Kenworthy, ATC

Practitioner Athletic Trainer Long Beach, MS

Practice location

Address: 312 Rita Ln, Long Beach, MS 39560-4338
Phone: (228) 234-4959

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT0159 (MS)

Other Specialist/Technologist providers in Mississippi →

Registry record

NPI: 1417362559
Entity type: Individual
Sex (as registered): Male
NPI issued: 27 Jun 2014
Record last updated: 27 Jun 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.