Provider Demographics
NPI:1558847368
Name:ATKINS, KATIE JEAN (IBCLC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JEAN
Last Name:ATKINS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 N QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3983
Mailing Address - Country:US
Mailing Address - Phone:479-879-2586
Mailing Address - Fax:
Practice Address - Street 1:2988 N QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3983
Practice Address - Country:US
Practice Address - Phone:479-879-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-131699174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARL-131699OtherLACTATION CONSULTANT