Active NPI
Julie Kolstad Clark
- Denturist
- Roseburg, OR
National Provider Identifier
1609589837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DT-TMP-10228509
- Practice address
- 150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042 - Phone
- (541) 672-9596
- NPI assigned
- Jan 3, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Denturist | 122400000X | DT-TMP-10228509 | OR | Primary |
Addresses
Primary practice location
150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042
Mailing address
847 SE Blakeley Ave
Roseburg, OR 97470-4828
Phone (541) 817-2181
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 |
|---|---|---|---|
| DT-TMP-10228509 | OR | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672704000000",
"number": "1609589837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 SE BLAKELEY AVE",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974704828",
"telephone_number": "541-817-2181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 NE KENNETH FORD DR",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974701042",
"telephone_number": "541-672-9596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JULIE",
"middle_name": "KOLSTAD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-03",
"last_updated": "2023-01-03",
"certification_date": "2023-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "OR",
"license": "DT-TMP-10228509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.