Individual
JENNIFER LYNN LUPER-LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1323 BIA ROUTE 4, FORT THOMPSON, SD 57339
(605) 245-1621
Mailing address
647 SIMMONS AVE SE, HURON, SD 57350-2955
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0490
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
ATHLETIC TRAINING BOARD OF CERTIFICATION
—
Enumeration date
06/14/2017
Last updated
06/14/2017
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