Provider Demographics
NPI:1982676839
Name:MATHIS, KEMBRA LEA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KEMBRA
Middle Name:LEA
Last Name:MATHIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CRESENT ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9411
Mailing Address - Country:US
Mailing Address - Phone:479-877-9345
Mailing Address - Fax:
Practice Address - Street 1:1801 SE J ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4295
Practice Address - Country:US
Practice Address - Phone:479-254-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 4192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer