Active NPI
Nicole Lorraine Clark, LAT, ATC
- Athletic Trainer
- Boise, ID
National Provider Identifier
1538196563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-208
- Practice address
- 1010 W Washington St
Boise, ID 83702-5446 - Phone
- (208) 854-4270
- Fax
- (208) 854-4271
- NPI assigned
- Jun 26, 2006
- Sex
- Female
- 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 | AT-208 | ID | Primary |
Addresses
Primary practice location
1010 W Washington St
Boise, ID 83702-5446
Mailing address
6472 W Parapet Dr
Boise, ID 83714-8849
Phone (208) 377-3597
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 |
|---|---|---|---|
| AT-208 | ID | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538196563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6472 W PARAPET DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837148849",
"telephone_number": "208-377-3597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 W WASHINGTON ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837025446",
"telephone_number": "208-854-4270",
"fax_number": "208-854-4271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "NICOLE",
"middle_name": "LORRAINE",
"name_prefix": "Ms.",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ID",
"license": "AT-208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.