Provider Demographics
NPI:1992246722
Name:WRIGHT, JENNIFER BRAITHWAITE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BRAITHWAITE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 S STATE ST
Mailing Address - Street 2:APT #2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1327
Mailing Address - Country:US
Mailing Address - Phone:919-539-7292
Mailing Address - Fax:
Practice Address - Street 1:600 S MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5202
Practice Address - Country:US
Practice Address - Phone:501-666-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 7662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer