Active NPI
Theresa Carlisle Clark, REGISTERED NURSE
- Registered Nurse
- Phenix City, AL
National Provider Identifier
1003056383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 166504
- Practice address
- 1900 Carriage Dr
Phenix City, AL 36867-2116 - Phone
- (706) 289-9327
- Fax
- (888) 547-2536
- NPI assigned
- Feb 26, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 166504 | GA | Primary |
Addresses
Primary practice location
1900 Carriage Dr
Phenix City, AL 36867-2116
Mailing address
1900 Carriage Dr
Phenix City, AL 36867-2116
Phone (706) 289-9327
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166504 | GA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235606400000",
"number": "1003056383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 CARRIAGE DR",
"city": "PHENIX CITY",
"state": "AL",
"postal_code": "368672116",
"telephone_number": "706-289-9327",
"fax_number": "888-547-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 CARRIAGE DR",
"city": "PHENIX CITY",
"state": "AL",
"postal_code": "368672116",
"telephone_number": "706-289-9327",
"fax_number": "888-547-2536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "THERESA",
"middle_name": "CARLISLE",
"name_prefix": "Ms.",
"credential": "REGISTERED NURSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-26",
"last_updated": "2009-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "166504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phenix City, AL
- Chimed Rehab Ficpc, PLLC
- Chimed Rehab Phenix City
- Christa D. Spann DMD, LLC
- Bryce Andrew Ciancio, ATC/L
- Corey Eugene Claiborne, DPT
- Columbus Ambulatory Healthcare Services, Inc.
- Columbus Hospice of Alabama
- Complete Family Dental, P C
- Complete Patient Services
- Comprehensive Therapuetic Assessments and Counseling
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.