DEBRA CLARK (NPI# 1720058282) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720058282 |
| Entity Type | Individual |
| Full Name | DEBRA CLARK |
| Credential | PA-C |
| Practice Address |
250 Charlois Blvd Winston Salem NC 27103-1508 |
| Mailing Address |
Medical Center Blvd Winston Salem NC 27157-0001 |
| Practice Telephone | 3367181000 |
| Practice Fax Number | 3367181052 |
| Mailing Fax Number | 3367163202 |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2016-04-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 103316 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8101696 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336525625 | Debra Clark | Nurse Practitioner | 1040 Vinehaven Dr Ne, Concord, NC 28025-2438 | 2015-08-10 |
| 1255683330 | Debra Ashley Clark | Audiologist | 1720 Peachtree St Nw Ste 200, Atlanta, GA 30309-2440 | 2012-10-12 |
| 1871816041 | Debra Striler Clark | Psychologist | 71 Walnut, Suite 109, Rochester, MI 48307-2073 | 2010-03-02 |
| 1952539785 | Debra Diane Clark | Reflexologist | 104 53rd Ave E, Bradenton, FL 34203-4702 | 2009-07-01 |
| 1720178650 | Debra Sue Clark | Physical Therapist | 3500 S Boulevard, Suite A, Edmond, OK 73013-5490 | 2006-10-13 |
| 1609896943 | Debra Jean Clark | Counselor | 10 Market St, Suite 5, Oneonta, NY 13820-2655 | 2006-07-20 |
| 1962473397 | Debra Clark | Family Medicine | 1409 Rt 9, Keeseville, NY 12944-2845 | 2006-02-01 |
| 1154665669 | Debra Mae Clark | Physical Therapy Assistant | 1502 E Centennial Dr, Pittsburg, KS 66762-6718 | 2012-11-21 |
| 1407144215 | Debra Lou Clark | Counselor | 3 Bridge St, Carthage, NY 13619-1353 | 2011-07-13 |
| 1790003218 | Debra Lynn Ann Clark | Licensed Practical Nurse | 116 Second St, Greenland, MI 49929 | 2010-05-07 |
| Street Address |
250 CHARLOIS BLVD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-1508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972503449 | Ryan Angus Mcdonald | Physician Assistant | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2005-07-27 |
| 1790266310 | Ashleigh Wynne Lucas | Nurse Practitioner | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2018-08-22 |
| 1841651841 | Alexandra Gilmore Sheppard | Physician Assistant | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2016-03-18 |
| 1922409234 | Tacorya Denise Morrison | Pharmacist | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2014-09-06 |
| 1831508860 | Sarah D Pearce | Pharmacist | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2014-08-04 |
| 1497183206 | Forsyth Memorial Hospital Inc | Internal Medicine | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-10-15 |
| 1265868764 | Forsyth Memorial Hospital, Inc | Internal Medicine | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-09-17 |
| 1083055396 | Phillip A Kelley | Physician Assistant | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-07-15 |
| 1427493980 | Marian Virginia Hazy | Nurse Practitioner | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2013-05-09 |
| 1609120690 | Tangula Latrice Simmons | Nurse Practitioner | 250 Charlois Blvd, Winston Salem, NC 27103-1508 | 2012-10-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| 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 |
|---|---|---|---|---|
| 1598375032 | Anthony Gentile | Physician Assistant | 2632 Wynbrook Dr, Winston Salem, NC 27103-8005 | 2020-08-07 |
| 1376152074 | Meera Shah | Physician Assistant | 3288 Robinhood Rd Ste 202, Winston Salem, NC 27106-5464 | 2020-07-28 |
| 1770118457 | Heather Leigh Bissell | Physician Assistant | 153 Lavender Ln, Winston Salem, NC 27107-6023 | 2020-03-03 |
| 1245899806 | Cheryl L Sizer | Physician Assistant | Wake Forest Baptist Health 1 Medical Center Blvd, Winston Salem, NC 27157-0001 | 2019-06-07 |
| 1235606575 | Vincent James Alderete | Physician Assistant | Wake Forest Baptist Health 1 Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2018-10-25 |
| 1386127538 | Frederick Keith Stirewalt | Physician Assistant | Medical Center Blvd Faithhealth, Winston Salem, NC 27157-0001 | 2018-09-13 |
| 1164936852 | Lindsay Webster | Physician Assistant | 10479 Nc-109, 107a, Winston Salem, NC 27107 | 2017-11-17 |
| 1518477694 | Raul Canchari Ames | Physician Assistant | 512 Waughtown St, Winston Salem, NC 27127-2236 | 2017-10-03 |
| 1922528611 | Devon Adams | Physician Assistant | 1 Medical Center Blvd Gastroenterology Dept, Winston Salem, NC 27157-7223 | 2017-06-22 |
| 1053862474 | Seguin Warwick Beuerlein | Physician Assistant | 2425 Riley Forest Dr, Winston Salem, NC 27127-7573 | 2016-10-20 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
Please comment or provide details below to improve the information on DEBRA 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.