MARISSA CLARK (NPI# 1194387431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194387431 |
| Entity Type | Individual |
| Full Name | MARISSA CLARK |
| Credential | PA-C |
| Practice Address |
112 Mansfield Ave Willimantic CT 06226-2040 |
| Mailing Address |
628 Spring St Manchester CT 06040-6746 |
| Practice Telephone | 8604569116 |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2020-11-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033633037 | Marissa Clark | Genetic Counselor, MS | 2827 Fort Missoula Rd., Suite 317, Missoula, MT 59804 | 2017-08-01 |
| 1326271644 | Marissa Everly Clark | Physical Therapist | 3115 W 6th St Ste B, Lawrence, KS 66049-3150 | 2009-09-02 |
| Street Address |
112 MANSFIELD AVE |
| City | WILLIMANTIC |
| State | CT |
| Zip Code | 06226-2040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962400630 | Robert Joseph Bundy | Internal Medicine | 112 Mansfield Ave, Pulmonary Dept., Hatch Wing, Willimantic, CT 06226-2041 | 2005-07-07 |
| 1033744289 | Lori Bernier | Social Worker | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2020-03-09 |
| 1720620065 | Alisa B Bray | Nurse Practitioner | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2019-10-08 |
| 1003301136 | Bethany Joy Kennedy | Nurse Practitioner | 112 Mansfield Ave, Willimantic, CT 06226 | 2018-07-01 |
| 1629475371 | Windham Community Memorial Hospital | Nurse Practitioner | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2014-11-24 |
| 1952708794 | Windham Community Memorial Hospital | Hospitalist | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2014-11-21 |
| 1174931687 | Melissa Bohan-hallenbeck | Nurse Practitioner | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2014-07-28 |
| 1689081085 | Prenatal Clinic | General Acute Care Hospital | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2014-07-17 |
| 1730477761 | Karin E Grann | Registered Nurse | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2011-07-12 |
| 1699062505 | Christopher Desmond | Nurse Practitioner | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2011-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669962163 | Nutmeg Neuropsychology LLC | Psychologist | 322 Main St Ste 2e-1o, Willimantic, CT 06226 | 2018-05-10 |
| 1104344365 | Taylor Girard | Social Worker | 54-56 Boston Post Road, Willimantic, CT 06226 | 2017-09-07 |
| 1194268490 | Donald Diange | Pharmacist | 1391 Main Street, Willimantic, CT 06226 | 2016-11-18 |
| 1386988954 | Gale K Lockland | Psychologist | 112 Mansfield Avenue, Windham Community Memorial Hospital, Willimantic, CT 06226 | 2012-11-20 |
| 1831343060 | Carlita R Baldwin | Counselor | 366 Ash Street, Unit 4, Willimantic, CT 06226 | 2008-11-14 |
| 1023211190 | Joel Lee Reinholtz | Physical Therapy Assistant | 595 Valley Street, Windham, CT 06226 | 2007-06-07 |
| 1265654719 | Mcsweeney Regional Senior Center | Clinic/Center | 47 Crescent St, Willimantic, CT 06226 | 2007-05-03 |
| 1912012964 | John Wescott Stevens | Dentist | 1581 W Main St, Willmantic, CT 06226 | 2006-08-20 |
| 1801802756 | Kathryn Nelson | Family Medicine | 355 High Street, Willimantic, CT 06226 | 2006-07-31 |
| 1710914379 | The Foot Group, LLC | Podiatrist | 162 A Mansfield Ave, Willimantic, CT 06226 | 2006-06-27 |
| Find all providers in zip 06226 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962557470 | Katherine Marie Baird | Physician Assistant | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2007-01-24 |
| 1528046646 | Tracy Hawthorne | Physician Assistant | 112 Mansfield Ave, Willimantic, CT 06226-2045 | 2006-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881295913 | Courtney Marquardt | Physician Assistant | 25 Buckland Rd, South Windsor, CT 06074-3703 | 2020-11-04 |
| 1154922623 | Alexis Cardinali | Physician Assistant | 175 S Meriden Rd, Cheshire, CT 06410-2973 | 2020-11-02 |
| 1689274417 | Danielle Kerr | Physician Assistant | 1055 Kennedy Rd, Windsor, CT 06095-1308 | 2020-10-30 |
| 1467051920 | Cynthia G Moreno | Physician Assistant | 76 Newtown Rd Ste C, Danbury, CT 06810-6265 | 2020-10-25 |
| 1245837764 | Lauren Tripodi | Physician Assistant | 9 Sunset Hill Rd, Newtown, CT 06470-1318 | 2020-10-07 |
| 1710594403 | Mary Josephine Elliott | Physician Assistant | 50 Beechwood Dr, Madison, CT 06443-1847 | 2020-09-26 |
| 1558977868 | Gabrielle Guetta | Physician Assistant | 25 Woody Ln, Westport, CT 06880-2260 | 2020-09-22 |
| 1609481639 | Gresi Kello | Physician Assistant | 506 Frost Rd, Waterbury, CT 06705-2304 | 2020-09-15 |
| 1477167351 | Connecticut Children's Eye Care, P.C. | Physician Assistant | 131 New London Tpke Ste 200, Glastonbury, CT 06033-2246 | 2020-09-08 |
| 1750991303 | Lana Chapman | Physician Assistant | 289 Curtis St Apt 2, Meriden, CT 06450-5910 | 2020-08-07 |
| Find all providers with the same taxonomy | ||||
| City | WILLIMANTIC |
| Zip Code | 06226 |
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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.