Individual
DESTINEE KATRINA COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2015 AGGIE RD, JONESBORO, AR 72401
(870) 972-3342
(870) 972-2052
Mailing address
PO BOX 480, STATE UNIVERSITY, AR 72467-0480
(970) 972-3342
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT880
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023000981
ARKANSAS STATE UNIVERSITY ATHLETIC TRAINING
AR
Enumeration date
07/18/2019
Last updated
07/18/2019
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