Madison Rae Clark

Key facts

NPI

1821531492

Entity type

Individual (NPI type 1)

Primary specialty

Student in an Organized Health Care Education/Training Program 390200000X

Practice address

15413 E 3Rd Ter S
Independence, MO 64050-2289

Phone

(816) 585-5717

NPI assigned

Nov 29, 2016

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 1, 2016.

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1821531492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 CENTRAL METHODIST SQ",
            "city": "FAYETTE",
            "state": "MO",
            "postal_code": "652481104",
            "telephone_number": "816-585-5717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15413 E 3RD TER S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640502289",
            "telephone_number": "816-585-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MADISON",
        "middle_name": "RAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-29",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

• Marcia Clapp
• Barbara J Clark, CRNA
• Breanna Faith Clark, MSN, FPMHNP
• Kyle A Clark, MS, LPC
• Laurie Beth Clark, CNP
• Amelia Gail Clausen, LCSW
• De'Nesha Clay
• Mason Clegg
• Donald J Clement, MD
• Cara A Clements, MA, LPC

All providers in Independence, MO · Student in an Organized Health Care Education/Training Program in Missouri