Kristin L Clark (NPI# 1710982756, PAC ID# 7517933823) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OBSTETRICS/GYNECOLOGY.
| Nation Provider ID (NPI) | 1710982756 |
| PAC ID by PECOS | 7517933823 |
| Professional Enrollment ID | I20040908000972 |
| Full Name | Kristin L Clark |
| Organization Legal Name | PREVEA CLINIC INC |
| Address |
1411 N Taylor Dr Prevea Sheboygan Haelth Center Sheboygan WI 53081-3043 |
| Phone Number | 9204964700 |
| Gender | F |
| Credential | MD |
| Medical School | UNIVERSITY OF WISCONSIN MEDICAL SCHOOL |
| Graduation Year | 2000 |
| Primary Specialty | OBSTETRICS/GYNECOLOGY |
| Group Practice PAC ID | 0042123150 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | M |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 520116 | WATERTOWN MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 200 Theda Clark Medical Plz, Suite 130, Neenah, WI 54956-2790 | 9207297105 | WOMENS CARE OF WISCONSIN SC |
| 1411 N Taylor Dr, Prevea Sheboygan Haelth Center, Sheboygan, WI 53081-3043 | 9204964700 | PREVEA CLINIC INC |
| 128 Hospital Dr, Watertown, WI 53098-3304 | 9202624825 | WATERTOWN PHYSICIAN PRACTICES LLC |
| 8901 W Lincoln Ave, West Allis, WI 53227-2409 | 4143286000 | OBHG WISCONSIN SC |
| Organization Legal Name | PREVEA CLINIC INC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sarah J Smith | Family Medicine | Prevea Clinic Inc | 1411 N Taylor Dr, Prevea Sheboygan Haelth Center, Sheboygan, WI 53081-3043 |
| Kaylee Elizabeth Hoppe | Physician Assistant | Prevea Clinic Inc | 1715 Dousman St, Green Bay, WI 54303-3211 |
| Street Address |
1411 N TAYLOR DR PREVEA SHEBOYGAN HAELTH CENTER |
| City | SHEBOYGAN |
| State | WI |
| Zip | 53081-3043 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jessica R Witt | Nurse Practitioner | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Mary L Roethel | Nurse Practitioner | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Jay L Christensen | Podiatry | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Melissa A Rodriguez | Nurse Practitioner | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Joseph C Mccormick Iii | Orthopedic Surgery | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Charles M Korankye | Family Medicine | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Amy S Gumieny | Nurse Practitioner | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Sarah M Olaso | Family Medicine | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Anne J Drewry | Family Medicine | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Olivia Afamefuna | Internal Medicine | St. Nicholas Hospital-sisters of The Third Order of St Francis | 1411 N Taylor Dr, Sheboygan, WI 53081-3043 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mary Kay K Howie | Clinical Social Worker | 4027 S Business Dr, Suite 205, Sheboygan, WI 53081-1261 | |
| Kenneth Scott Heinen | Chiropractic | 1539 N 33rd Pl B, Sheboygan, WI 53081-1839 | |
| Ashley S Perez | Physical Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Doris Uhlig Theune | Nurse Practitioner | Sheboygan Physicians Group S.c. | 3315 Superior Ave, Sheboygan, WI 53081-1861 |
| Alison Kescenovitz | Physical Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Stacia E Schmidt | Physical Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Alison J Risseeuw | Physical Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Kristen M Kaiser | Occupational Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Tracy L Dumke | Occupational Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Shannon M Diamond | Physical Therapy | St. Nicholas Hospital-sisters of The Third Order of St Francis | 3303 Superior Ave, Sheboygan, WI 53081-1861 |
| Find all physicians in zip 53081 | |||
| City | SHEBOYGAN |
| Zip Code | 53081 |
| Specialty | OBSTETRICS/GYNECOLOGY |
| City + Specialty | SHEBOYGAN + OBSTETRICS/GYNECOLOGY |
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| 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.