Active NPI
Clark Sebastian Shirley, AT, ATC
- Athletic Trainer
- Mesa, AZ
National Provider Identifier
1386054468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1142
- Practice address
- 7311 E Southern Ave Apt 2034
Mesa, AZ 85209-2712 - Phone
- (413) 348-3145
- NPI assigned
- Apr 29, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1142 | AZ | Primary |
Addresses
Primary practice location
7311 E Southern Ave Apt 2034
Mesa, AZ 85209-2712
Mailing address
7311 E Southern Ave Apt 2034
Mesa, AZ 85209-2712
Phone (413) 348-3145
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 |
|---|---|---|---|
| 1142 | AZ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1386054468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7311 E SOUTHERN AVE APT 2034",
"city": "MESA",
"state": "AZ",
"postal_code": "852092712",
"telephone_number": "413-348-3145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7311 E SOUTHERN AVE APT 2034",
"city": "MESA",
"state": "AZ",
"postal_code": "852092712",
"telephone_number": "413-348-3145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIRLEY",
"first_name": "CLARK",
"middle_name": "SEBASTIAN",
"name_prefix": "Mr.",
"credential": "AT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-29",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "1142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.