Active NPI
Joanna Zidick McClarey, MS, ATC
- Athletic Trainer
- Mexico, MO
National Provider Identifier
1700448685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2002025637
- Practice address
- 639 N Wade St
Mexico, MO 65265-1822 - Phone
- (573) 581-4296
- NPI assigned
- Jul 1, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2002025637 | MO | Primary |
Addresses
Primary practice location
639 N Wade St
Mexico, MO 65265-1822
Mailing address
639 N Wade St
Mexico, MO 65265-1822
Phone (573) 581-4296
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2002025637 | Other | MO | MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS: ATHLETIC TRAINER |
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 |
|---|---|---|---|
| 2002025637 | MO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666656000000",
"number": "1700448685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "639 N WADE ST",
"city": "MEXICO",
"state": "MO",
"postal_code": "652651822",
"telephone_number": "573-581-4296"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 N WADE ST",
"city": "MEXICO",
"state": "MO",
"postal_code": "652651822",
"telephone_number": "573-581-4296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLAREY",
"first_name": "JOANNA",
"middle_name": "ZIDICK",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-01",
"last_updated": "2022-10-25",
"certification_date": "2022-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2002025637",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS: ATHLETIC TRAINER",
"identifier": "2002025637",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mexico, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.