Individual
COREY AMBER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 WASHINGTON AVE, CONWAY, AR 72032-4115
(318) 525-7936
Mailing address
6 RELIANCE CT, MAYFLOWER, AR 72106-9455
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT991
AR
Other
Enumeration date
07/25/2022
Last updated
07/25/2022
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