Active NPI
Tyler Clark
- Student in an Organized Health Care Education/Training Program
- Saint Louis, MO
National Provider Identifier
1407308018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 7785 Keswick PL
Saint Louis, MO 63119 - Phone
- (573) 344-7009
- NPI assigned
- Oct 30, 2016
- Sex
- Male
- 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
7785 Keswick PL
Saint Louis, MO 63119
Mailing address
1900 McNatt Dr Apt 1
Brookland, AR 72417-9024
Phone (573) 344-7009
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529280000000",
"number": "1407308018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 MCNATT DR APT 1",
"city": "BROOKLAND",
"state": "AR",
"postal_code": "724179024",
"telephone_number": "573-344-7009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7785 KESWICK PL",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "63119",
"telephone_number": "573-344-7009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-30",
"last_updated": "2018-06-18",
"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 Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.