NPI 1144710815

Stephanie Blake, ATCLAT

Practitioner Athletic Trainer Walnut Ridge, AR

Practice location

Address: 60 W Fulbright St, Walnut Ridge, AR 72476-9000
Phone: (870) 208-5631
Mailing address: 211 Fairgrounds Rd, Harrisburg, AR 72432-1306

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT701 (AR)

Other Specialist/Technologist providers in Arkansas →

Registry record

NPI: 1144710815
Entity type: Individual
Sex (as registered): Female
NPI issued: 17 May 2018
Record last updated: 17 May 2018

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.