NPI 1083053763

Dara E Moak, ATC

Practitioner Athletic Trainer Brookhaven, MS

Practice location

Address: 507 Highway 51 N, Brookhaven, MS 39601-2334
Phone: (601) 835-0842
Mailing address: 2625 Heucks Retreat Rd NE, Wesson, MS 39191-9467

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT0441 (MS)

Other Specialist/Technologist providers in Mississippi →

Registry record

NPI: 1083053763
Entity type: Individual
Sex (as registered): Female
NPI issued: 17 Jun 2013
Record last updated: 17 Jun 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.