Joan T. Stark, MA

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

1776574 Issued in NM

Practice address

1000 E Aztec Ave
Gallup, NM 87301-5509

Phone

(505) 721-1825

Fax

(505) 721-1899

NPI assigned

Apr 9, 2007

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

Other identifiers 1

Other names 1

• Samantha Stark Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gallup McKinley County Schools

  • Local Education Agency (LEA)
  • Gallup, NM
  • NPI 1730210113
  NPD (past)

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851414429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 NIZHONI BLVD APT B5",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873017128",
            "telephone_number": "505-722-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E AZTEC AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015509",
            "telephone_number": "505-721-1825",
            "fax_number": "505-721-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "JOAN",
        "middle_name": "T.",
        "name_prefix": "Ms.",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NM",
            "license": "1776574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56306091",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "STARK",
            "credential": "MA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dana Springer, RPH
• Henry M Stachura, M.D.
• Michelle Stam-Maclaren, MD
• Alyson Marie Stambaugh, PHARMD
• Jay Thomas Stanley, RN
• Marissa Stark
• Judith Starr
• Nicholas Daniel Stauffer, PHARMD
• Laura Ann Steed, RN
• Joshua James Steele

• School Psychologist in Gallup, NM
• Providers in Gallup, NM by specialty
• School Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.