Nicole TM Clark, ATC-L

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

AT511 Issued in ME

Practice address

267 Ocean Ave
Portland, ME 04103-5707

Phone

(207) 542-8233

NPI assigned

Aug 7, 2014

Last updated

Aug 7, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407369600000",
    "number": "1841609484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 OCEAN AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035707",
            "telephone_number": "207-542-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 OCEAN AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035707",
            "telephone_number": "207-542-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "middle_name": "TM",
        "name_prefix": "Miss",
        "credential": "ATC-L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "ME",
            "license": "AT511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Alison Clark, LCSW
• Matthew Anthony Clark, DO
• Meagan Jenkins Clark, MD
• Michelle Ruth Clark, PA-C
• Nathaniel P Clark, LCPC-C
• Troy William Clark, LCSW
• William P Clark
• Beth S Clarke, LCSW
• Rebecca Lynn Clarkin, PMHNP
• Karen Terese Clarkson, RN

• Sports Medicine (Emergency Medicine) Physician in Portland, ME
• Providers in Portland, ME by specialty
• Sports Medicine (Emergency Medicine) Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.