Andrew Benjamin Clark, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

24-01693 Issued in KS

Practice address

10700 Nall Ave
Overland Park, KS 66211-1206

Phone

(912) 574-1908

NPI assigned

Jan 13, 2023

Last updated

Jan 12, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736640000000",
    "number": "1467167429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 E MAIN ST",
            "city": "ANTHONY",
            "state": "KS",
            "postal_code": "670032706",
            "telephone_number": "620-842-2475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 NALL AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111206",
            "telephone_number": "912-574-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANDREW",
        "middle_name": "BENJAMIN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-13",
        "last_updated": "2025-01-12",
        "certification_date": "2025-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KS",
            "license": "24-01693",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2023035873",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED ATHLETIC TRAINER",
            "identifier": "200054219",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Overland Park Fire Department
• Brieanna Lauren Claassen, MA, LPC, NCC
• Daniel Carter Claiborn, PH.D.
• Claire Selin, LLC
• Clarified Nutrition LLC
• Andrew Jeffrey Clark, DC
• Anne S. Clark, M.D.
• Carolyn Mae Clark, M.D.
• Cindy Clark, COTA
• David Frederick Clark, MD

• Athletic Trainer in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Athletic Trainer in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2025; 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.