CAROL CLARK (NPI# 1770535502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770535502 |
| Entity Type | Individual |
| Full Name | CAROL CLARK |
| Credential | CNP |
| Practice Address |
9015 E 17th St Indianapolis IN 46229-2016 |
| Practice Telephone | 3178983166 |
| Practice Fax Number | 3178984219 |
| Mailing Telephone | 3178983166 |
| Mailing Fax Number | 3178984219 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-05-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
71000959A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71000959A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200307710 | 05 | |
| IN | RR MEDICARE PTAN | P01016729 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336520295 | Carol H Clark | Psychologist | 210 Lowry St, Kerrville, TX 78028-5274 | 2015-06-16 |
| 1669656450 | Carol T Clark | Case Management | 300 East Walnut, Suite 200, Pasadena, CA 91101 | 2007-12-28 |
| 1477606044 | Carol L Clark | Counselor | 11651 W Biscayne Canal Rd, Miami, FL 33161-6132 | 2007-01-18 |
| 1053343681 | Carol Shelby Clark | Occupational Therapist | 1647 Mallory Ln, Suite 103, Brentwood, TN 37027-2909 | 2006-07-06 |
| 1649734310 | Carol Riley Clark | Pharmacist | 621 Commerce St, Earle, AR 72331-1616 | 2019-01-28 |
| 1265938302 | Carol Clark | Counselor | 2311 E 98th St, Chicago, IL 60617-4842 | 2018-04-05 |
| 1215441936 | Carol Clark | Case Manager/Care Coordinator | 1095 Sugarview Dr, Sheridan, WY 82801-5386 | 2017-11-17 |
| 1255783940 | Carol Clark | Social Worker | 3125 Poplarwood Ct, Raleigh, NC 27604-1084 | 2016-07-06 |
| 1235503004 | Carol Jones Clark | Speech-Language Pathologist | 550 Roselawn Ave E, Maplewood, MN 55117-2120 | 2015-11-17 |
| 1790192144 | Carol Clark | Massage Therapist | 10 N Roselle Rd, Roselle, IL 60172-1592 | 2014-07-17 |
| Street Address |
9015 E 17TH ST |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46229-2016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316907009 | Jared Christopher Basham | Family Medicine | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-03-25 |
| 1982174454 | Melissa Jane Smith | Nurse Practitioner | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2018-11-27 |
| 1528422516 | Roddrea Montgomery | Family Medicine | 9015 E 17th St, Indianapolis, IN 46229 | 2016-04-06 |
| 1063891679 | Naseem Labue | Family Medicine | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2015-05-28 |
| 1841389335 | Beth E Pretti | Nurse Practitioner | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-10-12 |
| 1134143837 | Farouk Khairy | Family Medicine | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-07-26 |
| 1619990413 | Arnold E Brown Jr. | Family Medicine | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-07-25 |
| 1053334854 | Peiyi Hu | Family Medicine | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-07-25 |
| 1316967011 | Leann S Emery | Nurse Practitioner | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-07-19 |
| 1497792451 | Community Hospitals of Indiana Inc | Internal Medicine | 9015 E 17th St, Indianapolis, IN 46229-2016 | 2006-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487150124 | Patrice R. Mosley | Registered Nurse | 9385 E Washington St, Indianapolis, IN 46229 | 2018-04-02 |
| 1013424621 | Latasha Fisher | Registered Nurse | 9822 Fulbrook Dr, Indianapolis, IN 46229 | 2018-01-04 |
| 1417324856 | Ourhealth Physicians Group, LLC | Clinic/Center | 9934 E Washington Street, Indianapolis, IN 46229 | 2015-09-01 |
| 1134479470 | Loving Hands Senior Care and Relocation | In Home Supportive Care | 9702 E Washington Ste 400 Pmd 185, Indianapolis, IN 46229 | 2012-09-13 |
| 1902155815 | Planned Parenthood of Indiana Eastside | Clinic/Center | 9385 E. Washington St., Indianapolis, IN 46229 | 2012-09-06 |
| 1407092497 | Amy Katherine Graham | Chiropractor | 11020 E 10th St Ste B, Indianapolis, IN 46229 | 2008-12-23 |
| 1043408610 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 9630 Washington Street, Indianapolis, IN 46229 | 2007-10-09 |
| 1487867024 | Holli A H Bowser | Dietitian, Registered | 9660 E Washington St, Indianapolis, IN 46229 | 2007-05-08 |
| 1336361708 | Dental Professionals of Indiana, P.C. | Dentist | 986 North Mitthoeffer, Indianapolis, IN 46229 | 2007-05-03 |
| 1386865558 | Gary Lee Bacon | Dentist | 316 Washington Pointe Drive, Indianapolis, IN 46229 | 2007-05-02 |
| Find all providers in zip 46229 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386244176 | Mallory Lee Anslow | Nurse Practitioner | 10641 Deercrest Ln, Indianapolis, IN 46239-9690 | 2020-10-29 |
| 1922614965 | Children Express Care Clinic LLC | Nurse Practitioner | 5435 Emerson Way Ste 110, Indianapolis, IN 46226-1470 | 2020-09-16 |
| 1255956272 | Heather Nicole Zore | Nurse Practitioner | 9240 N Meridian St Ste 225, Indianapolis, IN 46260-1880 | 2020-06-15 |
| 1457976615 | Adam Weir | Nurse Practitioner | 960 E Washington St, Indianapolis, IN 46202-3981 | 2020-06-13 |
| 1457975740 | Ayee Teah Bleemie | Nurse Practitioner | 429 E Vermont St Ste 100, Indianapolis, IN 46202-3688 | 2020-06-02 |
| 1689294357 | May Josefa Ishikawa | Nurse Practitioner | 705 Riley Hospital Dr Ste 2240, Indianapolis, IN 46202-5109 | 2020-04-22 |
| 1760001200 | John Shaver | Nurse Practitioner | 3750 N Meridian St Ste 100, Indianapolis, IN 46208-4300 | 2020-04-14 |
| 1851931000 | Robin L Petit | Nurse Practitioner | 6925 S Harding St Ste B-1, Indianapolis, IN 46217-4114 | 2020-01-15 |
| 1952941577 | Andreya Beckett | Nurse Practitioner | 3500 Depauw Blvd Ste 1041, Indianapolis, IN 46268-6125 | 2020-01-11 |
| 1053950105 | Shannon Malecki | Nurse Practitioner | 550 University Blvd Ste 5630, Indianapolis, IN 46202-5149 | 2020-01-06 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46229 |
Please comment or provide details below to improve the information on CAROL 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.