Active NPI
Sarah Clark
- Peer Specialist
- Ammon, ID
National Provider Identifier
1033964796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 163
- Practice address
- 2705 E 17TH St
Ammon, ID 83406-6669 - Phone
- (208) 346-7500
- Fax
- (307) 333-0470
- NPI assigned
- Apr 17, 2024
- Sex
- Female
- Sole proprietor
- No
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
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 163 | ID | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
2705 E 17TH St
Ammon, ID 83406-6669
Mailing address
1621 E 49TH S Apt 2107
Idaho Falls, ID 83404-7897
Phone (208) 403-4364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 13, 2026.
{
"created_epoch": "1713312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1033964796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 E 49TH S APT 2107",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047897",
"telephone_number": "208-403-4364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2705 E 17TH ST",
"city": "AMMON",
"state": "ID",
"postal_code": "834066669",
"telephone_number": "208-346-7500",
"fax_number": "307-333-0470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SARAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-17",
"last_updated": "2026-07-13",
"certification_date": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "ID",
"license": "163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Ammon, ID
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.