Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Clark Mantooth

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1710737770

Clark Mantooth is a Student in an Organized Health Care Education/Training Program in Nellis AFB, Nevada. Licensed in Virginia. Registered with an NPI since 2024.

Licensed in
VA
In the registry since
2024
Specialties on file
2

Practice location Address checks out

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6601
Phone: (702) 653-2273
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence 102209624 (VA)
Military Health Care Provider Taxonomy 171000000X

Record details

NPI number1710737770
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 25, 2024
Last updated in NPPESMarch 5, 2026
Certification dateMarch 5, 2026
Mailing address4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6601

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