Active NPI
Liam Conor Clark
- Athletic Trainer
- West Lafayette, IN
National Provider Identifier
1992357438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 900 N John R Wooden Dr
West Lafayette, IN 47907-2117 - Phone
- (765) 494-3245
- Fax
- (765) 494-9899
- NPI assigned
- Jul 15, 2019
- Sex
- Male
- Sole proprietor
- No
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 | IN | Primary |
Addresses
Primary practice location
900 N John R Wooden Dr
West Lafayette, IN 47907-2117
Mailing address
900 N John R Wooden Dr
West Lafayette, IN 47907-2117
Phone (765) 494-3245
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": "1563148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563148800000",
"number": "1992357438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 N JOHN R WOODEN DR",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479072117",
"telephone_number": "765-494-3245",
"fax_number": "765-494-9899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N JOHN R WOODEN DR",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479072117",
"telephone_number": "765-494-3245",
"fax_number": "765-494-9899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LIAM",
"middle_name": "CONOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-15",
"last_updated": "2019-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.