Active NPI
Melanie A Clark
- Psychiatry Physician
- Kalamazoo, MI
National Provider Identifier
1356732465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 4301059375
- Practice address
- 930 Southern Ave
Kalamazoo, MI 49001-4337 - Phone
- (269) 207-5998
- NPI assigned
- Feb 11, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 4301059375 | MI | Primary |
Addresses
Primary practice location
930 Southern Ave
Kalamazoo, MI 49001-4337
Mailing address
930 Southern Ave
Kalamazoo, MI 49001-4337
Phone (269) 207-5998
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301059375 | MI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423612800000",
"number": "1356732465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 SOUTHERN AVE",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490014337",
"telephone_number": "269-207-5998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 SOUTHERN AVE",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490014337",
"telephone_number": "269-207-5998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MELANIE",
"middle_name": "A",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-11",
"last_updated": "2015-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301059375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.