Active NPI
Colleen Cloak, RN
- Registered Nurse
- Coudersport, PA
National Provider Identifier
1760019293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN534665
- Practice address
- 1 N Main St
Coudersport, PA 16915-1630 - Phone
- (814) 274-8651
- Fax
- (814) 274-8652
- NPI assigned
- Mar 25, 2020
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN534665 | PA | Primary |
Addresses
Primary practice location
1 N Main St
Coudersport, PA 16915-1630
Mailing address
1 N Main St
Coudersport, PA 16915-1630
Phone (814) 274-8651
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
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN534665 | PA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dickinson Center, Inc | Current | Accepting new patients |
Locations
1 N Main St
Coudersport, PA 16915
Phone (814) 274-8651
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Ridgway, PA
- NPI 1164503322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585094400000",
"number": "1760019293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 N MAIN ST",
"city": "COUDERSPORT",
"state": "PA",
"postal_code": "169151630",
"telephone_number": "814-274-8651",
"fax_number": "814-274-8652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 N MAIN ST",
"city": "COUDERSPORT",
"state": "PA",
"postal_code": "169151630",
"telephone_number": "814-274-8651",
"fax_number": "814-274-8652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLOAK",
"first_name": "COLLEEN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-25",
"last_updated": "2020-03-25",
"certification_date": "2020-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN534665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coudersport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.