Healthcare Provider Details

I. General information

NPI: 1982537890
Provider Name (Legal Business Name): LAURA ELIZABETH LYNN MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 N STADIUM DR
FAYETTEVILLE AR
72701-5472
US

IV. Provider business mailing address

3400 GENE GEORGE BLVD APT F206
SPRINGDALE AR
72762-1046
US

V. Phone/Fax

Practice location:
  • Phone: 870-476-6776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: