Active NPI
Ida Alicia Russell, ATC
- Athletic Trainer
- Little Rock, AR
National Provider Identifier
1700841038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 293
- Practice address
- 424 N University Ave
Little Rock, AR 72205-3109 - Phone
- (501) 661-0336
- Fax
- (501) 661-0412
- NPI assigned
- Apr 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 293 | AR | Primary |
Addresses
Primary practice location
424 N University Ave
Little Rock, AR 72205-3109
Mailing address
3408 Silica Heights Rd
Benton, AR 72015-5622
Phone (501) 860-6601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 293 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1700841038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3408 SILICA HEIGHTS RD",
"city": "BENTON",
"state": "AR",
"postal_code": "720155622",
"telephone_number": "501-860-6601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 N UNIVERSITY AVE",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722053109",
"telephone_number": "501-661-0336",
"fax_number": "501-661-0412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "IDA",
"middle_name": "ALICIA",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-19",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.