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Individual

MRS. AUDREY SHAE WILLINGHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LAT, ATC

Contact information

Practice address
2137 W SKYLER DR, FAYETTEVILLE, AR 72703-1274
(417) 793-1232
Mailing address
2137 W SKYLER DR, FAYETTEVILLE, AR 72703-1274
(417) 793-1232

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT 757
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2000021229
BOARD OF CERTIFICATION
Enumeration date
01/19/2015
Last updated
10/26/2016
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