Ryan Steven Clark, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A161295706 Issued in WA

Practice address

9040A Jackson Ave
Joint Base Lewis McChord, WA 98431-0001

Phone

(208) 819-5174

NPI assigned

May 31, 2019

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

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": "1559260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1528626959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 N 45TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984073724",
            "telephone_number": "208-819-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040A JACKSON AVE",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "208-819-5174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "middle_name": "STEVEN",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-31",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WA",
            "license": "A161295706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelvin K Chan, M.D.
• Andrea Lynn Charlton, D.O.
• Cassy Chateau
• Sonya Elena Chiba Kelley
• Stephen Gene Chong, MD
• Brigitte Ann Clary, RN
• Clickcare, LLC
• Maria Sarah Cole, CRNA
• Maribel Collins, RN
• Kimberly Connell, RDH

• Athletic Trainer in Joint Base Lewis McChord, WA
• Providers in Joint Base Lewis McChord, WA by specialty
• Athletic Trainer in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; 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.