Individual
MISS RILEY RUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.T.C., L.A.T.
Contact information
Practice address
1100 E 14TH ST, ADA, OK 74820-6915
(580) 559-5532
Mailing address
1600 S HARKRIDER ST, CONWAY, AR 72032-8066
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
904
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000025671
BOARD OF CERTIFICATION (BOC)
—
01
—
904
ARKANSAS STATE BOARD OF ATHLETIC TRAINING
AR
01
—
948
OKLAHOMA MEDICAL BOARD
OK
Enumeration date
01/10/2017
Last updated
02/03/2021
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