Jacqueline Marie Komarek, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

7507 Warden Rd
Sherwood, AR 72120-5042

Phone

(501) 301-4530

Fax

(501) 251-1165

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physical Therapy Institute

  • Physical Therapy Clinic/Center
  • Little Rock, AR
  • NPI 1497077648
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1104470806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 RAHLING RD APT 408",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722234651",
            "telephone_number": "501-317-7348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7507 WARDEN RD",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "721205042",
            "telephone_number": "501-301-4530",
            "fax_number": "501-251-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMAREK",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Sherwood",
            "affiliation": "Y",
            "affiliationName": "Physical Therapy Institute",
            "address_1": "7507 Warden Rd",
            "city": "Sherwood",
            "state": "AR",
            "country_code": "US",
            "postal_code": "721205042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Abigail Grace King
• Melissa Jo Emily Kirchner
• Shantell Knowlton, B.S, SLPA
• Ramona Lynn Koehler, MSP CCC-SLP
• Brian Koesy, PHARM.D
• Macy Rebekah Kottler, PHARMD
• Ali Krisht, MD
• Khaled M Krisht
• Mami Kuwano, BT
• L. M. Henderson D.M.D.,P.a.

• Athletic Trainer in Sherwood, AR
• Providers in Sherwood, AR by specialty
• Athletic Trainer in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.