Terry A Clinkenbeard, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

5449 Issued in ND

Practice address

200 Highway 2 W
Devils Lake, ND 58301-3532

Phone

(701) 665-2200

Fax

(701) 665-2300

NPI assigned

Jun 16, 2006

Last updated

Jan 24, 2012By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1003850231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583010650",
            "telephone_number": "701-665-2200",
            "fax_number": "701-665-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HIGHWAY 2 W",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013532",
            "telephone_number": "701-665-2200",
            "fax_number": "701-665-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLINKENBEARD",
        "first_name": "TERRY",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "5449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054518",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "000481",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE ID",
            "identifier": "260035844",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Mae Christofferson
• Victoria Church, LAC
• Callie Ann Clark
• Clinic Pharmacy Inc
• James R Clinkenbeard, MD
• Megan Gean Clinton
• Sarah Ann Coenen
• James Michael Cole, MSW, LCSW
• Stacy Yvonne Connor
• Thomas C. Corbett, M.D.

• Psychiatry Physician in Devils Lake, ND
• Providers in Devils Lake, ND by specialty
• Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.