Healthcare Provider Details

I. General information

NPI: 1972031870
Provider Name (Legal Business Name): MEREDITH MORGAN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S HAMPTON DR
CONWAY AR
72034-4847
US

IV. Provider business mailing address

409 S HAMPTON DR
CONWAY AR
72034-4847
US

V. Phone/Fax

Practice location:
  • Phone: 501-269-8613
  • Fax:
Mailing address:
  • Phone: 501-269-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: