Nicole Clark, LAT, ATC
Individual provider Active NPI Athletic Trainer · Bloomfield, IN
NPI 1871968768 · NPPES record last updated Dec 3, 2015
Key facts
- NPI
- 1871968768
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 36001806A (IN)
- Practice address
- 332 Wilson Dr
Bloomfield, IN 47424-1054 - Phone
- (317) 432-3861
- NPI assigned
- Dec 3, 2015
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36001806A | IN | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36001806A | IN | Yes |
Addresses
Primary practice location
332 Wilson Dr
Bloomfield, IN 47424-1054
Mailing address
332 Wilson Dr
Bloomfield, IN 47424-1054
Phone (317) 432-3861
Other providers in Bloomfield, IN
- Aaron W Brown
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- Franklin Wayne Burton
- Corey Busk
- Jay Louis Cimmer
- Kari Dawn Cochenour
- Cory Brett Cramer
- Julia G Crane
- Joshua Cullison
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All providers in Bloomfield, IN · Athletic Trainer in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.