MRS. LISA L. CLARK (NPI# 1801160353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801160353 |
| Entity Type | Individual |
| Full Name | MRS. LISA L. CLARK |
| Credential | FNP |
| Practice Address |
1005 Boulder Dr Gray GA 31032 |
| Mailing Address |
1005 Boulder Dr Gray GA 31032-6141 |
| Practice Telephone | 4786212100 |
| Practice Fax Number | 4787440481 |
| Mailing Telephone | 4786212100 |
| Mailing Fax Number | 4787440481 |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2019-07-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN089162 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003179288A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4421 Carnes St, Acworth, GA 301015305 | 4786212072 | 6785408623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154776912 | Lisa Clark | Counselor | 8722 Heaton St, New Orleans, LA 70118-2616 | 2016-04-29 |
| 1548694383 | Lisa G Clark | Speech-Language Pathologist | 2405 Champaign Ave, Mattoon, IL 61938-2646 | 2013-08-28 |
| 1073857801 | Lisa Ann Clark | Specialist | 1110 Chenango St, Binghamton, NY 13901-1668 | 2012-11-16 |
| 1952680324 | Lisa S Clark | Counselor | 1223 Meadow Lake Rd, Rockledge, FL 32955-8403 | 2011-08-16 |
| 1134456445 | Lisa Lynn Clark | Occupational Therapist | 85 Lunt Rd, Brunswick, ME 04011-7289 | 2009-11-06 |
| 1437485836 | Lisa Landers Clark | Counselor | 1 Waterford Ln, Savannah, GA 31411-1305 | 2009-10-20 |
| 1710146220 | Lisa M Clark | Nurse Practitioner | University Hosp Medical Center Stony Brk, Dept Pediatrics Hsc 11th Floor, Stony Brook, NY 11794-0001 | 2008-06-09 |
| 1376742841 | Lisa M Clark | Specialist | 4308 N 26th St, Tacoma, WA 98407-5211 | 2007-07-15 |
| 1356453260 | Lisa M Clark | Dentist | Bonham Family Dentistry, 101 E 9th Street, Bonham, TX 75418 | 2006-08-31 |
| 1598779100 | Lisa Bardy Clark | Family Medicine | 12815 Highway 98 West, Suite 116, Destin, FL 32550 | 2006-07-28 |
| Street Address |
1005 BOULDER DR |
| City | GRAY |
| State | GA |
| Zip Code | 31032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548263064 | Wyatt Kenny Blake | Family Medicine | 1005 Boulder Dr, Gray, GA 31032 | 2005-05-30 |
| 1134781073 | Michael Kelly | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032-6141 | 2019-07-01 |
| 1356807507 | Sarah Rose Purser | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032-6141 | 2019-02-13 |
| 1548760556 | Brianna Carolyn Jo Ramseur | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032-6141 | 2018-02-16 |
| 1932650173 | Shannon Dawn Coffee | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2016-10-24 |
| 1720475098 | N'kema Cooper | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2015-04-23 |
| 1740629443 | Betty Lou Yul Riner | Clinical Nurse Specialist | 1005 Boulder Dr, Gray, GA 31032 | 2013-06-17 |
| 1235574906 | Heather Lewis | Physician Assistant | 1005 Boulder Dr, Gray, GA 31032 | 2013-05-07 |
| 1245584788 | Catherine Marie Wilson | Nurse Practitioner | 1005 Boulder Dr, Gray, GA 31032 | 2012-11-06 |
| 1336492511 | Community Primary Care of Georgia LLC | Family Medicine | 1005 Boulder Dr, Gray, GA 31032-6141 | 2012-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225669120 | True Essential Service, LLC | Home Health | 112 Madison Avenue, Gray, GA 31032 | 2020-01-29 |
| 1740640234 | Tuquester L. Carlisle | Marriage & Family Therapist | 300 West Clinton St., Suite I, Gray, GA 31032 | 2016-02-26 |
| 1821404161 | Linda Norman Greene | Home Health Aide | 3562 Gray Highway, Gray, GA 31032 | 2014-07-08 |
| 1770876781 | Gray Dental Associates, P.C. | Dentist | 242 West Clinton St, Gray, GA 31032 | 2011-05-24 |
| 1245404516 | Louise E Simmons | Nurse's Aide | 426 Liberty Street, Gray, GA 31032 | 2008-04-17 |
| 1396929568 | Albert H Mcgalliard | Pharmacist | 236 West Clinton St, Gray, GA 31032 | 2007-12-24 |
| 1184845067 | Todd F Kelleher | Chiropractor | 4292 Gray Highway, Gray, GA 31032 | 2007-05-01 |
| 1477690014 | S & S Medical Management Services, Inc | Durable Medical Equipment & Medical Supplies | 221 West Clinton Street, Suite F, Gray, GA 31032 | 2007-01-31 |
| 1235290859 | River Edge Behavorial Health Center | Community/Behavioral Health | 324 Highway 18 East, Gray, GA 31032 | 2006-12-13 |
| 1437211067 | River Edge Behavioral Health Center | Community/Behavioral Health | 502 West Clinton Street, Gray, GA 31032 | 2006-12-13 |
| Find all providers in zip 31032 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659934834 | Marianne Kimes | Nurse Practitioner | 798 Mckay Rd, Gray, GA 31032-3816 | 2019-04-15 |
| 1942717152 | Vickie Ann Mills | Nurse Practitioner | 147 Smith Hollow Rd, Gray, KY 40734-6574 | 2018-01-09 |
| 1457781353 | Kathryn Baker | Nurse Practitioner | 10755 N. Us Hwy 25e, Gray, KY 40734-7032 | 2013-11-14 |
| 1275673873 | Andree Elizabeth Leblanc | Nurse Practitioner | 123 Frontage Road A, Gray, LA 70359-6301 | 2007-02-06 |
| 1205905254 | Edna Eugenia Stewart | Nurse Practitioner | 39 Cumberland Gap Plaza, Gray, KY 40734-1401 | 2006-11-06 |
| 1740383157 | William Joseph Cote | Nurse Practitioner | 132 Old Gray Station Road, Gray, TN 37615-3434 | 2006-09-07 |
| 1194717157 | Susan Kay Pennypacker | Nurse Practitioner | 140 Old Gray Station Rd, Suite 200, Gray, TN 37615 | 2005-08-16 |
| 1497382162 | Rebecca Ann Alexander | Nurse Practitioner | 132 Old Gray Station Rd, Gray, TN 37615-3434 | 2020-03-24 |
| 1578195467 | Rachel A Edwards | Nurse Practitioner | 2103 Forest Dr Ste 5, Gray, TN 37615-8423 | 2020-02-07 |
| 1972069722 | Courtney Carroll | Nurse Practitioner | 2103 Forest Dr Ste 5, Gray, TN 37615-8423 | 2019-02-18 |
| Find all providers in GRAY | ||||
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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.