Active NPI
Jeffrey Clevenger, M.S.
- Athletic Trainer
- Lafayette, IN
National Provider Identifier
1619341856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36000065A
- Practice address
- 1801 S 18TH St
Lafayette, IN 47905-2011 - Phone
- (765) 772-4711
- NPI assigned
- Nov 28, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36000065A | IN | Primary |
Addresses
Primary practice location
1801 S 18TH St
Lafayette, IN 47905-2011
Mailing address
2043 E 430 S
Lafayette, IN 47909-8105
Phone (765) 772-4711
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36000065A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448668800000",
"number": "1619341856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2043 E 430 S",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479098105",
"telephone_number": "765-772-4711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 S 18TH ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479052011",
"telephone_number": "765-772-4711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVENGER",
"first_name": "JEFFREY",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-28",
"last_updated": "2015-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36000065A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.