MR. KENNETH R CLARK (NPI# 1821119959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821119959 |
| Entity Type | Individual |
| Full Name | MR. KENNETH R CLARK |
| Practice Address |
4211 Hospital St Ste 104 Pascagoula MS 39581-5310 |
| Mailing Address |
2415 Beach Blvd Pascagoula MS 39567-1422 |
| Practice Telephone | 2287621940 |
| Practice Fax Number | 2287627786 |
| Mailing Telephone | 2286231392 |
| Mailing Fax Number | 2287627786 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2017-11-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | E-06773 | MS | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275056889 | Kenneth Clark | Hearing Instrument Specialist | 304 E Broadway St Ste 20, Mount Pleasant, MI 48858-2364 | 2017-07-25 |
| 1063887834 | Kenneth Eugene Clark | Occupational Therapy Assistant | 4885 Eldon Dr S, Colorado Springs, CO 80916-4431 | 2015-12-04 |
| 1104487149 | Kenneth John Clark | Hearing Instrument Specialist | 462 Roosevelt Rd, Glen Ellyn, IL 60137-5611 | 2019-06-20 |
| 1144740580 | Kenneth John Clark Jr. | Physical Therapist | 6119 Deltona Blvd, Spring Hill, FL 34606-1011 | 2017-06-27 |
| 1619336229 | Kenneth Clark | Dentist | 2524 Hillside Heights Dr, Green Bay, WI 54311-6777 | 2016-02-11 |
| 1669878443 | Kenneth Clark | Registered Nurse | 724 N Charlotte St, Pottstown, PA 19464-4607 | 2014-11-06 |
| 1598046401 | Kenneth Dale Clark | Orthotist | 9303 Pinecroft Dr, The Woodlands, TX 77380-3181 | 2011-09-06 |
| 1093012783 | Kenneth Howard Clark | Pathology | 200 Lothrop St, Pittsburgh, PA 15213-2536 | 2011-02-16 |
| 1568794725 | Kenneth Andrew Clark II | Marriage & Family Therapist | 10800 Financial Centre Pkwy Ste 290, Little Rock, AR 72211-3581 | 2010-02-12 |
| 1942344031 | Kenneth L Clark | Registered Nurse | 2640 Breslauer Way, Redding, CA 96001-4246 | 2007-02-20 |
| Street Address |
4211 HOSPITAL ST STE 104 |
| City | PASCAGOULA |
| State | MS |
| Zip Code | 39581-5310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760945448 | Jacquelyn B Ellison | Nurse Practitioner | 4105 Hospital Road, Ste 103, Pascagoula, MS 39581 | 2019-04-10 |
| 1104346816 | Jennifer Ngoc Bui | Dentist | 4001 Denny Ave Suite 1, Pascagoula, MS 39581 | 2017-06-23 |
| 1528486289 | Thomas Stallworth | Nurse Practitioner | 4105 Hospital St Ste 104, Pascagoula, MS 39581 | 2014-03-31 |
| 1487919957 | Candace Noel Pendowski | Nurse Practitioner | 4211 Hospital St Suite 208, Pascagoula, MS 39581 | 2012-07-10 |
| 1649548892 | Kim M. Tumminello | Nurse Practitioner | 4253 Denny Avenue, Pascagoula, MS 39581 | 2011-12-02 |
| 1649547860 | Abrian Norell Flowers | Physical Therapist | 3537 Denny Avenue, Suite 115, Pascagoula, MS 39581 | 2011-11-17 |
| 1164724118 | Coast To Coast Rehab LLC | Rehabilitation Practitioner | 3537 Denny Ave, Suite 115, Pascagoula, MS 39581 | 2010-11-24 |
| 1740500958 | Joshua Eric Tucker | Physical Medicine & Rehabilitation | 4105 Hospital St Ste 112b, Pascagoula, MS 39581 | 2010-06-10 |
| 1720164916 | Vernon W Doster | Family Medicine | 3616 Hospital Street, Suite D, Pascagoula, MS 39581 | 2006-10-31 |
| 1841387727 | David Bruce Allen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4300 Hospital Rd, Suite 105, Pascagoula, MS 39581 | 2006-10-10 |
| Find all providers in zip 39581 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760852370 | Christopher Wilkerson | Pharmacist | 1607 Woodhaven St, Pascagoula, MS 39581-2247 | 2015-09-25 |
| 1316548068 | Brittney Huong Nguyen | Pharmacist | 4253 Denny Ave, Pascagoula, MS 39581-5502 | 2020-11-07 |
| 1427664317 | Jason Lee | Pharmacist | 3800 Market St, Pascagoula, MS 39567-3036 | 2020-09-16 |
| 1164900882 | Molly Rector O'bryant | Pharmacist | 4253 Denny Ave, Pascagoula, MS 39581-5507 | 2018-08-03 |
| 1831626746 | Matthew Milton Johnson | Pharmacist | 3800 Market St, Pascagoula, MS 39567-3036 | 2017-05-23 |
| 1285005009 | Dana Patrice Hill | Pharmacist | 3800 Market St, Pascagoula, MS 39567-3036 | 2015-10-20 |
| 1033580584 | David Wilson | Pharmacist | 3800 Market St, Pascagoula, MS 39567-3036 | 2015-10-09 |
| 1306249867 | Tammy Freeman | Pharmacist | 4253 Denny Ave, Pascagoula, MS 39581-5502 | 2014-09-29 |
| 1700288412 | Lena Murphy | Pharmacist | 4253 Denny Ave, Pascagoula, MS 39581-5502 | 2014-09-24 |
| 1407137417 | Christopher Ryan Travis | Pharmacist | 3800 Market St, Pascagoula, MS 39567-3036 | 2011-09-02 |
| Find all providers in PASCAGOULA | ||||
| City | PASCAGOULA |
| Zip Code | 39581 |
Please comment or provide details below to improve the information on MR. KENNETH R 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.