Active NPI
Carly Clark
- Student in an Organized Health Care Education/Training Program
- Fort Collins, CO
National Provider Identifier
1356921746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 4601 S Mason St
Fort Collins, CO 80525-3740 - Phone
- (970) 493-5334
- NPI assigned
- Apr 10, 2021
- Last updated
- Aug 21, 2026
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
4601 S Mason St
Fort Collins, CO 80525-3740
Mailing address
4601 S Mason St
Fort Collins, CO 80525-3740
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: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787270400000",
"number": "1356921746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 S MASON ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805253740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 S MASON ST",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805253740",
"telephone_number": "970-493-5334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CARLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-10",
"last_updated": "2026-08-21",
"certification_date": "2026-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; 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.