Provider Demographics
NPI:1306203393
Name:WARD, IVA DARKINA (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:IVA
Middle Name:DARKINA
Last Name:WARD
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:IVA
Other - Middle Name:DARKINA
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LAT,ATC
Mailing Address - Street 1:2011 GLENGATE CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6967
Mailing Address - Country:US
Mailing Address - Phone:843-385-6415
Mailing Address - Fax:
Practice Address - Street 1:WILLIAM B AYCOCK BUILDING
Practice Address - Street 2:590 MANNING DRIVE , CAMPUS BOX 7595
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:984-984-2257
Practice Address - Fax:919-966-6126
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-16532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLAT-1653OtherLICENCED ATHLETIC TRAINER
NC2000000710OtherATHLETIC TRANIER CARTIFIED