Healthcare Provider Details

I. General information

NPI: 1407764947
Provider Name (Legal Business Name): CAMPBELL ELIZABETH FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 910
STATE UNIVERSITY AR
72467-0910
US

IV. Provider business mailing address

75 COUNTY ROAD 7429
WYNNE AR
72396-5005
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-3822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2255A2300X
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: