CHRISTOPHER LEE CLARK (NPI# 1497983332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497983332 |
| Entity Type | Individual |
| Full Name | CHRISTOPHER LEE CLARK |
| Credential | IDMT |
| Practice Address |
5179 Malmstrom Ave Nellis Afb NV 89191-6126 |
| Mailing Address |
5197 Malmstrom Ave. Nellis Afb NV 89191 |
| Practice Telephone | 7026521542 |
| Mailing Telephone | 7026521542 |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2009-06-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194286955 | Christopher James Clark | Student in an Organized Health Care Education/Training Program | 2390 W Congress St # 2, Lafayette, LA 70506-4205 | 2019-03-26 |
| 1801383351 | Christopher Clark | Case Management | 43a Richfield Rd, Upper Darby, PA 19082-2517 | 2018-04-20 |
| 1285088385 | Christopher Clark | Occupational Therapist | 101 Applied Bank Blvd Ste D4, Glen Mills, PA 19342 | 2016-04-15 |
| 1912322694 | Christopher W Clark | Military Health Care Provider | G544 C Street, Camp Lejuene, NC 28542 | 2014-03-04 |
| 1144657248 | Christopher Alex Clark | Counselor | 900 Corbitt Dr, Wilmore, KY 40390-1096 | 2013-10-03 |
| 1427480490 | Christopher James Clark | Counselor | 2817 E 97th Pl Apt 1506, Tulsa, OK 74137-7334 | 2013-08-01 |
| 1912341892 | Christopher Michael Clark | Otolaryngology | 48 Medical Park Dr E Ste 153, Birmingham, AL 35235-3459 | 2013-04-23 |
| 1992053474 | Christopher Tad Clark | Counselor | 1471 Dewar Dr Ste 204, Rock Springs, WY 82901-5826 | 2012-08-15 |
| 1215257217 | Christopher David Clark | Physical Medicine & Rehabilitation | 1165 Imperial Dr Ste 103, Hagerstown, MD 21740-6555 | 2010-06-02 |
| 1992922454 | Christopher B Clark | Dentist | 28321 Kensington Ln, Perrysburg, OH 43551-4164 | 2007-04-19 |
| Street Address |
5179 MALMSTROM AVE |
| City | NELLIS AFB |
| State | NV |
| Zip Code | 89191-6126 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225662687 | Ashley Raye Roth-garcia | Student in an Organized Health Care Education/Training Program | 99th Medical Group 4700 Las Vegas Blvd North, Nellis Afb, NV 89191 | 2020-02-25 |
| 1427553734 | Christopher Robert Weisgarber | Student in an Organized Health Care Education/Training Program | Mike O'callaghan Military Medical Center, 4700 Las Vegas Blvd North Bldg 1300, Las Vegas, NV 89191 | 2018-03-28 |
| 1912345448 | Austin Joseph Ladner | Dentist | 99th Air Base Wing Public Affairs, Fpo, AA 89191 | 2013-06-06 |
| 1528329018 | Mayer M Jeppson | Psychologist | 4700 Las Vegas Blvd. N, Nellis Afb, NV 89191 | 2012-05-31 |
| 1255560462 | Jordan Lawrence | Military Health Care Provider | 1579 Malmstrom Avenue, Nellis Afb, NV 89191 | 2009-07-09 |
| 1225263072 | Adrienne L Clark | Military Health Care Provider | 5154 Ellsworth Ave, Suite 61690, Las Vegas, NV 89191 | 2009-05-22 |
| 1568634335 | Eleanor C Basilio | Registered Nurse | 4700 Las Vegas Blvd., Nellis Afb, NV 89191 | 2008-04-01 |
| 1316137037 | Sarah Rachel Glick | Pediatrics | 4700 N. Las Vegas Blvd., Mike O'callaghan Federal Medical Center, 99 Mdos/sgoc, Nellis Afb, NV 89191 | 2007-07-30 |
| 1619181302 | Ben Carter Robinson | Orthopaedic Surgery | 4700 N. Las Vegas Blvd, Nellis Afb-mofh Nellis Orthopedics, Las Vegas, NV 89191 | 2007-05-10 |
| 1609992205 | Conrad Lochner IIi, Odpc | Optometrist | 5691 Rickenbacker Road, Bldg. 431, Las Vegas, NV 89191 | 2007-03-22 |
| Find all providers in zip 89191 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255560462 | Jordan Lawrence | Military Health Care Provider | 1579 Malmstrom Avenue, Nellis Afb, NV 89191 | 2009-07-09 |
| 1245837392 | Cameron Springer | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-10-01 |
| 1801404397 | Madelyn Danielle Golden | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-07-21 |
| 1851931869 | Jesse Eduardo Beltran | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2020-01-08 |
| 1417480054 | Daniel Potter | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2017-04-11 |
| 1780037036 | Codie James White | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2016-07-21 |
| 1639503444 | Hugo Silva | Military Health Care Provider | 4311 Carswell Ave, Bldg 340, Nellis Afb, NV 89191-7069 | 2013-08-28 |
| 1306104021 | Kayleigh Madison Mcaviney | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2012-05-01 |
| 1215295936 | Paula Lynn Moungsiharat | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2012-05-01 |
| 1093041774 | Nicole B Ernst | Military Health Care Provider | 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | 2009-10-30 |
| Find all providers in NELLIS AFB | ||||
| City | NELLIS AFB |
| Zip Code | 89191 |
Please comment or provide details below to improve the information on CHRISTOPHER LEE CLARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.