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NPI Code Detail

MEDICARE: MRS. WHITNEY RACHEL SULLIVAN ATC, LAT

MEDICARE: MRS. WHITNEY RACHEL SULLIVAN ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAT439AR

General Provider Information

NPI Number : 1093047722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WHITNEY RACHEL SULLIVAN ATC, LAT
Provider Business Mailing Address
First Line : 221 N. 10TH
Second Line :
City : DE QUEEN
State : AR
Zip : 71832-3003
Country : US
Telephone Number : 870-582-4201
Fax Number :
Provider Business Practice Location Address
First Line : 22 SOUTHPARK SHOPPING CTR
Second Line :
City : NASHVILLE
State : AR
Zip : 71852-3307
Country : US
Telephone Number : 870-845-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2010
Last Update Date : 02/05/2010

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Directions to “ MRS. WHITNEY RACHEL SULLIVAN ATC, LAT” Practice Location

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