Individual
MRS. JACQUELINE KENNEDY MILLWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, LAT, ATC
Contact information
Practice address
1991 FORDHAM DR STE 100, FAYETTEVILLE, NC 28304-3774
(910) 484-3114
(910) 484-8824
Mailing address
1991 FORDHAM DR STE 100, FAYETTEVILLE, NC 28304-3774
(910) 484-3114
(910) 484-8824
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1717
NC
Other
Enumeration date
11/07/2011
Last updated
03/26/2015
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