Active NPI
Gina Clark
- Family Nurse Practitioner
- Fort Carson, CO
National Provider Identifier
1225843766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F02250032
- Practice address
- 1650 Cochrane Cir
Fort Carson, CO 80913-4613 - Phone
- (719) 524-0016
- NPI assigned
- Feb 11, 2025
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F02250032 | CO | Primary |
Addresses
Primary practice location
1650 Cochrane Cir
Fort Carson, CO 80913-4613
Mailing address
6445 Wilson Rd
Colorado Springs, CO 80919-3524
Phone (720) 935-3575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F02250032 | CO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1225843766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6445 WILSON RD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809193524",
"telephone_number": "720-935-3575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 COCHRANE CIR",
"city": "FORT CARSON",
"state": "CO",
"postal_code": "809134613",
"telephone_number": "719-524-0016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GINA",
"sole_proprietor": "YES",
"sex": "U",
"enumeration_date": "2025-02-11",
"last_updated": "2025-02-11",
"certification_date": "2025-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CO",
"license": "F02250032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Carson, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.