Provider Demographics
NPI:1316401961
Name:LOYALL, LAUREN (ATC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LOYALL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:CPO 2172
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40404-9801
Mailing Address - Country:US
Mailing Address - Phone:859-985-4156
Mailing Address - Fax:
Practice Address - Street 1:215 CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1451
Practice Address - Country:US
Practice Address - Phone:502-637-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
5743-6674-5708OtherNREMT