Active NPI
Justin B Clark, LAT, ATC
- Athletic Trainer
- Abilene, KS
National Provider Identifier
1487606380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2400410
- Practice address
- 511 NE 10TH St
Abilene, KS 67410-2153 - Phone
- (785) 263-6664
- NPI assigned
- May 17, 2006
- Last updated
- Jul 12, 2007
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2400410 | KS | Primary |
Addresses
Primary practice location
511 NE 10TH St
Abilene, KS 67410-2153
Mailing address
511 NE 10TH St
PO Box 123
Abilene, KS 67410-2153
Phone (785) 263-6664
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 |
|---|---|---|---|
| 2400410 | KS | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1487606380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 NE 10TH ST",
"address_2": "PO BOX 123",
"city": "ABILENE",
"state": "KS",
"postal_code": "674102153",
"telephone_number": "785-263-6664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 NE 10TH ST",
"city": "ABILENE",
"state": "KS",
"postal_code": "674102153",
"telephone_number": "785-263-6664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JUSTIN",
"middle_name": "B",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "KS",
"license": "2400410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Abilene, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.