Active NPI
Kristen Clark, MS, ATC
- Athletic Trainer
- Grants Pass, OR
National Provider Identifier
1023575891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1025091
- Practice address
- 537 Union Ave
Grants Pass, OR 97527-5543 - Phone
- (541) 761-0048
- NPI assigned
- Feb 27, 2019
- 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 | 1025091 | OR | Primary |
Addresses
Primary practice location
537 Union Ave
Grants Pass, OR 97527-5543
Mailing address
PO Box 726
Merlin, OR 97532-0726
Phone (541) 761-0048
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1025091 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551225600000",
"number": "1023575891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 726",
"city": "MERLIN",
"state": "OR",
"postal_code": "975320726",
"telephone_number": "541-761-0048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "537 UNION AVE",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975275543",
"telephone_number": "541-761-0048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTEN",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-27",
"last_updated": "2019-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "1025091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.