Individual
MRS. LACI LYNN BAURER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
100 EAST UNIVERSITY, MAGNOLIA, AR 71754
(870) 235-5229
(870) 235-4988
Mailing address
502 WARNOCK SPRINGS RD, MAGNOLIA, AR 71753
(501) 416-3876
(870) 235-4988
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT 431
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090202032
BOARD OF CERTIFICATION NUMBER
—
Enumeration date
07/26/2013
Last updated
07/26/2013
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