Individual
JAMES MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5538 GOLDEN WILLOW DR, FORT COLLINS, CO 80528-6395
(404) 840-3413
Mailing address
5538 GOLDEN WILLOW DR, FORT COLLINS, CO 80528-6395
(404) 840-3413
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
182988
NC
163W00000X
Registered Nurse
RN.1672019
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
078222
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
APN.0996173-CRNA
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052948
—
NC
Enumeration date
07/18/2007
Last updated
04/08/2026
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