Devan Clark, LMT

Primary specialty

SpecialistTaxonomy code 174400000X

License

107485 Issued in AK

Practice address

3540 N Snow Goose Dr
Wasilla, AK 99654-2505

Phone

(419) 961-3818

NPI assigned

Sep 8, 2016

Last updated

Sep 8, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1473292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473292800000",
    "number": "1497202279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 N SNOW GOOSE DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996542505",
            "telephone_number": "419-961-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 N SNOW GOOSE DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996542505",
            "telephone_number": "419-961-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEVAN",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-08",
        "last_updated": "2016-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "107485",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "MT-21190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wayne Anthony Cissell, D.C.
• Mark Clafshenkel, RPH
• Richard Clampitt
• Adam Dawson Clark
• Christy Clark, LMT
• Elizabeth Marie Clark, LMT
• Zackariah Clark
• Uriah Josiah Clarkson, RPH
• Classic Eyeware
• Matthew R Clayton

• Specialist in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Specialist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; 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.