Brett A Waldon, MS, ATC, LAT, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT313 Issued in AR

Practice address

1306 N El Paso Ave
Russellville, AR 72801-8814

Phone

(479) 968-0642

Fax

(479) 498-6044

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437004800000",
    "number": "1457408353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 VICTORIA DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729046364",
            "telephone_number": "479-285-4263",
            "fax_number": "479-498-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 N EL PASO AVE",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728018814",
            "telephone_number": "479-968-0642",
            "fax_number": "479-498-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDON",
        "first_name": "BRETT",
        "middle_name": "A",
        "credential": "MS, ATC, LAT, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2015-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AR",
            "license": "AT313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meagan Votteler
• W. Bruce Brown MD, PA. (Arkansas Orthopaedic Center)
• Mary Wade
• Wal-Mart Stores, Inc. (Vision Center 30-0058)
• Kathryn Elisabeth Waldo
• Stacy Waldron, PHARMD
• Walgreen Co (Walgreens #10199)
• Walgreen Co (Walgreens # 15243)
• Bethany Ann Walker, PA-C
• Emily Walker

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; 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.