Individual
LAKEN BRYANNE PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. ATC
Contact information
Practice address
79 WINDING WAY RD, BRISTOL, VA 24201-3039
(276) 466-6603
Mailing address
79 WINDING WAY RD, BRISTOL, VA 24201-3039
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000027829
BOC
—
Enumeration date
05/25/2017
Last updated
06/16/2018
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