Active NPI
Dallas Brose
- Athletic Trainer
- Clarksville, AR
National Provider Identifier
1962067132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 854
- Practice address
- 415 N College Ave
Clarksville, AR 72830-2880 - NPI assigned
- May 3, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 854 | AR | Primary |
Addresses
Primary practice location
415 N College Ave
Clarksville, AR 72830-2880
Mailing address
415 N College Ave
Clarksville, AR 72830-2880
Other practice location 1
415 N College Ave
Clarksville, AR 72830-2880
Phone (918) 850-2112
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556841600000",
"number": "1962067132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 N COLLEGE AVE",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728302880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 N COLLEGE AVE",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "728302880"
}
],
"practiceLocations": [
{
"address_1": "415 N College Ave",
"address_purpose": "LOCATION",
"city": "Clarksville",
"state": "AR",
"postal_code": "728302880",
"country_code": "US",
"telephone_number": "918-850-2112",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BROSE",
"first_name": "DALLAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-03",
"last_updated": "2019-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AR",
"license": "854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.