SHAWN FAYARD (NPI# 1689908352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689908352 |
| Entity Type | Individual |
| Full Name | SHAWN FAYARD |
| Credential | ATC |
| Practice Address |
103 Medical Park Hattiesburg MS 39401-9042 |
| Mailing Address |
Po Box 778 Purvis MS 39475-0778 |
| Practice Telephone | 6012685630 |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2020-10-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
AT0472 | MS | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | NATIONAL ATHLETIC TRAINER'S ASSOCIATION BOARD OF CERTIFICATION ( | 010702011 | 01 |
| MS | NATIONAL ATHLETIC TRAINER'S ASSOCIATION (NATA) | 1005471 | 01 |
| MS | MISSISSIPPI DEPARTMENT OF HEALTH LICENSURE | AT0472 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 149 Drinkwater Rd, Bay St Louis, MS 395201658 | 2284678725 | 2284678724 |
| Street Address |
103 MEDICAL PARK |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-9042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821102740 | Robert Clint Hudson | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2006-08-18 |
| 1407470990 | Hattiesburg Clinic, Pa | Physical Medicine & Rehabilitation | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2020-06-01 |
| 1811548696 | Lauren Mckenzy Reynolds | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2019-09-24 |
| 1962051946 | John Reynolds Clark | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2019-09-11 |
| 1821655150 | Nancy Danielle Lewis | Physical Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2019-05-22 |
| 1255869665 | Jennifer Lacroix Gunther | Nurse Practitioner | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2017-05-30 |
| 1518347681 | John Michael Porter | Occupational Therapist | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2015-06-04 |
| 1306254255 | Jessica Mccallister Tullos | Emergency Medicine | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2014-07-23 |
| 1063848075 | Rowdy Chance Lee | Physician Assistant | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2013-09-23 |
| 1144517822 | Jeremy Blake Wells | Family Medicine | 103 Medical Park, Hattiesburg, MS 39401-9042 | 2011-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942817895 | Thaxton Sullivan | Specialist/Technologist | 3 Courtland Dr Apt 50, Hattiesburg, MS 39402-8186 | 2020-09-24 |
| 1396225025 | Leslie Oglesby | Specialist/Technologist | 118 College Dr # 5122, Hattiesburg, MS 39406-0001 | 2018-08-21 |
| 1629556907 | Samuel Trent Morris | Specialist/Technologist | 221 Pine Ln, Hattiesburg, MS 39402-9213 | 2018-07-30 |
| 1154809457 | Alexandra C Flint | Specialist/Technologist | 12 Park Pl Apt 188f, Hattiesburg, MS 39402-1481 | 2018-07-30 |
| 1588152029 | Zachary Russell Walker | Specialist/Technologist | 820 Johnson Ave, Hattiesburg, MS 39402-2721 | 2018-04-30 |
| 1427559731 | Regan Ashley Nicholson I | Specialist/Technologist | 118 College Dr., Hattiesburg, MS 39406 | 2018-02-22 |
| 1154838183 | Amanda Mcbride | Specialist/Technologist | 25 Dunleith Ct, Hattiesburg, MS 39402-8866 | 2017-12-29 |
| 1477065779 | Evan Denoux | Specialist/Technologist | 216 Westover Dr Apt 17d, Hattiesburg, MS 39402-1375 | 2017-10-26 |
| 1326560319 | Shanickwa Jackson | Specialist/Technologist | 7 Lakewood Dr, Hattiesburg, MS 39402-9425 | 2017-07-11 |
| 1619406196 | Courtney Nicole Dossett | Specialist/Technologist | 807 Pineview Dr, Hattiesburg, MS 39401-7460 | 2017-06-08 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.