Healthcare Provider Details

I. General information

NPI: 1063167864
Provider Name (Legal Business Name): ANNA ELIZABETH LAFEVER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 UNIVERSITY DR
MONTICELLO AR
71655
US

IV. Provider business mailing address

108 FOX RUN LN
MONTICELLO AR
71655-8967
US

V. Phone/Fax

Practice location:
  • Phone: 870-460-1026
  • Fax:
Mailing address:
  • Phone: 870-723-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: