Individual provider Active NPI

Cheryl Ann Clark, M.D.

  • Psychiatry Physician
  • Denver, CO
National Provider Identifier
1447250675
Registry record updated Feb 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
27073 Issued in CO
Practice address
4141 E Dickenson PL
Denver, CO 80222-6012
Phone
(303) 504-6675
Fax
(303) 782-0916
NPI assigned
Jul 29, 2005
Last updated
Feb 1, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 27073 CO Primary

Addresses

Primary practice location

4141 E Dickenson PL
Denver, CO 80222-6012

Mailing address

4141 E Dickenson PL
Denver, CO 80222-6012
Phone (303) 504-6675

Other identifiers 1

IdentifierTypeStateIssuer
01270735MedicaidCO

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
27073COMDPsychiatry Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296518400000",
    "number": "1447250675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 E DICKENSON PL",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802226012",
            "telephone_number": "303-504-6675",
            "fax_number": "303-782-0916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 E DICKENSON PL",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802226012",
            "telephone_number": "303-504-6675",
            "fax_number": "303-782-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHERYL",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2011-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "27073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01270735",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.