Provider Demographics
NPI:1427564319
Name:BEARD, ARDEJAH (SCAT, LAT, ATC, EMTB)
Entity Type:Individual
Prefix:
First Name:ARDEJAH
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:SCAT, LAT, ATC, EMTB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-3778
Mailing Address - Country:US
Mailing Address - Phone:864-492-8914
Mailing Address - Fax:
Practice Address - Street 1:1115 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3778
Practice Address - Country:US
Practice Address - Phone:864-492-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NC146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2044OtherATHLETIC TRAINER