Clark Mantooth

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

102209624 Issued in VA

Practice address

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6601

Phone

(702) 653-2273

NPI assigned

Mar 25, 2024

Last updated

Mar 5, 2026By the provider in NPPES

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": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1710737770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916601",
            "telephone_number": "702-653-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916601",
            "telephone_number": "702-653-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTOOTH",
        "first_name": "CLARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-25",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "102209624",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter J Malamet, DO
• Laura Malchodi, MD
• Jose G Mangrobang Jr., PA-C
• Lisa Marie Mannina, M.D.
• Sarah Ashley Manning, MD
• Jacen S Mapes, PA-C
• Mira Kate Marchioretto
• Daniel Marciel, PSY.D.
• Sarah Marcotte
• John Marren, PA

• Student in an Organized Health Care Education/Training Program in Nellis AFB, NV
• Providers in Nellis AFB, NV by specialty
• Student in an Organized Health Care Education/Training Program in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.