Provider Demographics
NPI:1033609995
Name:COLVEY, MISTY DAWN (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:COLVEY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:DAWN
Other - Last Name:COLVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:707 CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-307-5900
Mailing Address - Fax:
Practice Address - Street 1:60 W FULBRIGHT AVENUE
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476
Practice Address - Country:US
Practice Address - Phone:870-759-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer