MANDY CLARK (NPI# 1104426261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104426261 |
| Entity Type | Individual |
| Full Name | MANDY CLARK |
| Credential | PNP |
| Practice Address |
610 Nuckolls Rd Bolivar TN 38008-1532 |
| Mailing Address |
246 Stonehaven Cv Jackson TN 38305-2036 |
| Practice Telephone | 7316587111 |
| Mailing Telephone | 4794096330 |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
248143 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316144389 | Mandy Clark | Counselor | 1030 Ne Couch St., Portland, OR 97232 | 2007-07-02 |
| 1861843336 | Mandy Clark | Case Manager/Care Coordinator | 1415 Truxtun Ave, Bakersfield, CA 93301-5215 | 2016-06-27 |
| 1740616846 | Mandy Clark | Nurse Practitioner | 1 Medical Center Blvd, Cookeville, TN 38501-4294 | 2013-09-20 |
| Street Address |
610 NUCKOLLS RD |
| City | BOLIVAR |
| State | TN |
| Zip Code | 38008-1532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134255078 | Robert Wayne Dunavant | Family Medicine | 610 Nuckolls Rd, Bolivar, TN 38008-1532 | 2007-02-26 |
| 1720297708 | Bolivar Medical Clinic | Family Medicine | 610 Nuckolls Rd, Bolivar, TN 38008-1532 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720639172 | Shanna Shackelford | Nurse Practitioner | 11100 Old Hwy 64 W, Bolivar, TN 38008 | 2019-09-26 |
| 1598326233 | Holly Brooke Shourd | Family Medicine | 1359 W Market St., Bolivar, TN 38008 | 2019-06-24 |
| 1992299234 | Angela Dawn Haynes | Registered Nurse | 10825 Hwy 64w, Bolivar, TN 38008 | 2018-06-20 |
| 1326595919 | Ashley Evon Jowers | Nurse Practitioner | 11100 Old Hwy 64 West, Bolivar, TN 38008 | 2016-09-01 |
| 1942458344 | Anita Pearl Johnson | Physical Therapy Assistant | 700 Knuckolls Ave, Bolivar, TN 38008 | 2008-08-28 |
| 1841340007 | State of Tennessee | Public Health or Welfare | 10825 Old Hwy 64, Bolivar, TN 38008 | 2007-01-11 |
| 1164479721 | Betty Ragon Lenoir | Physical Therapist | 789 Tennessee St, Bolivar, TN 38008 | 2006-05-28 |
| 1689623050 | County of Hardeman | Ambulance | 735 Naylor St, Bolivar, TN 38008 | 2006-05-10 |
| 1841287109 | Michiel Brent Rudder | Family Medicine | 622 West Market Street, Bolivar, TN 38008 | 2005-10-03 |
| 1982606497 | Richard Mast Reinhard IIi | Pediatrics | 629 Nuckolls Rd, Bolivar, TN 38008 | 2005-08-15 |
| Find all providers in zip 38008 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003381815 | Rebekah Kathleen Rossetta | Nurse Practitioner | 629 Nuckolls Rd, Bolivar, TN 38008-1599 | 2018-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003416330 | Laura Jean Schmid | Nurse Practitioner | 2200 Childrens Way Ste 3103, Nashville, TN 37232-0034 | 2020-10-27 |
| 1801495338 | Heidi Bevans | Nurse Practitioner | 1440 Cedar Ln, Tullahoma, TN 37388-2485 | 2020-10-26 |
| 1629683453 | Monique Kyles | Nurse Practitioner | 148 Marrakesh Cir, Memphis, TN 38103-5830 | 2020-09-09 |
| 1164034013 | Donte Leonard | Nurse Practitioner | 952 Dolly Parton Pkwy, Sevierville, TN 37862-3707 | 2020-08-21 |
| 1114545050 | Regina Jill Brown | Nurse Practitioner | 1441 Guthrie Dr Nw, Cleveland, TN 37311-3642 | 2020-07-07 |
| 1295350361 | Amber Rose King | Nurse Practitioner | 439 N Graham St, Memphis, TN 38122-3831 | 2020-06-14 |
| 1346869302 | Ashley O'brien | Nurse Practitioner | 1044 Oak Drive, White Bluff, TN 37187-3718 | 2020-04-10 |
| 1487298634 | Madison Hatfield | Nurse Practitioner | 2200 Childrens Way Fl 8, Nashville, TN 37232-0005 | 2019-10-31 |
| 1184267270 | Mary Elizabeth Coletti | Nurse Practitioner | 1029 W Main St # 3301, Lebanon, TN 37087-3351 | 2019-10-22 |
| 1508408956 | Stephanie Nidiffer | Nurse Practitioner | 3328 Jenkins Rd Ste 200, Chattanooga, TN 37421-1298 | 2019-10-16 |
| Find all providers with the same taxonomy | ||||
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| 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.