Shanta Lynn Clark (NPI# 1790169688, PAC ID# 3870808231) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1790169688 |
| PAC ID by PECOS | 3870808231 |
| Professional Enrollment ID | I20150813010500 |
| Full Name | Shanta Lynn Clark |
| Organization Legal Name | POKAGON BAND OF POTAWATOMI INDIANS |
| Address |
32652 Kno Dowagiac MI 49047-9805 |
| Phone Number | 2697824141 |
| Gender | F |
| Graduation Year | 2015 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 3476455445 |
| Number of Group Practice Members | 16 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230021 | LAKELAND HOSPITAL, ST JOSEPH |
| Address | Phone | Organization |
|---|---|---|
| 32652 Kno, Dowagiac, MI 49047-9805 | 2697824141 | POKAGON BAND OF POTAWATOMI INDIANS |
| Organization Legal Name | POKAGON BAND OF POTAWATOMI INDIANS |
| Physicians | 11 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marcy Parisi | Nurse Practitioner | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Leon E Sherburn | Family Medicine | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Eric Chamberlin | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Michelle M Cockey | Nurse Practitioner | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Melody D Pillow | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Laura Miller | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Patrick Loughlin | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Emily Sossoman | Nurse Practitioner | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Cynthia J Grate | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Marcy H Herbert | Registered Dietitian Or Nutrition Professional | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Street Address |
32652 KNO |
| City | DOWAGIAC |
| State | MI |
| Zip | 49047-9805 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Marcy Parisi | Nurse Practitioner | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Leon E Sherburn | Family Medicine | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Eric Chamberlin | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Michelle M Cockey | Nurse Practitioner | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Melody D Pillow | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Laura Miller | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Patrick Loughlin | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Emily Sossoman | Nurse Practitioner | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Cynthia J Grate | Clinical Social Worker | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Marcy H Herbert | Registered Dietitian Or Nutrition Professional | Pokagon Band of Potawatomi Indians | 32652 Kno, Dowagiac, MI 49047-9805 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mohammed A Ranginwala | Internal Medicine | 106 S Lowe St, Dowagiac, MI 49047-1624 | |
| Timothy J Dowsett | Chiropractic | 301 Commercial St, Dowagiac, MI 49047-1701 | |
| Kyle Michael Mckamey | Chiropractic | 114 Commercial St, Fl 2, Dowagiac, MI 49047-1727 | |
| Antonio Gonzales | Chiropractic | 114 Commercial St, Dowagiac, MI 49047-1727 | |
| John H Riggs Iii | Chiropractic | 206 W Division St, Dowagiac, MI 49047-1734 | |
| Bradley P Mundy | Optometry | Drs Steven and Brenda Smoke Od PC | 105 Pennsylvania Ave, Dowagiac, MI 49047-1748 |
| Aftab Ansari | Orthopedic Surgery | Ascension Borgess Lee Hospital | 520 Main St, Dowagiac, MI 49047-1762 |
| Srinivasan Dhatreecharan | Cardiovascular Disease (cardiology) | Ascension Borgess Lee Hospital | 520 Main St, Dowagiac, MI 49047-1762 |
| Abbas R Syed | General Surgery | Ascension Borgess Lee Hospital | 520 Main St, Dowagiac, MI 49047-1762 |
| Hemasri Tokala | Hematology/oncology | Ascension Borgess Lee Hospital | 420 W High St, Lee Memorial Hospital Corporation, Dowagiac, MI 49047-1943 |
| Find all physicians in zip 49047 | |||
| City | DOWAGIAC |
| Zip Code | 49047 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | DOWAGIAC + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Shanta Lynn Clark.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.