Carolyn Teresa Clark, RN BSN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN308661L Issued in PA

Practice address

1155 E Mountain Blvd
Wilkes Barre, PA 18702-7906

Phone

(570) 808-7920

Fax

(570) 808-6006

NPI assigned

Jul 7, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1003434069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 E MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027906",
            "telephone_number": "570-808-7920",
            "fax_number": "570-808-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 E MOUNTAIN BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027906",
            "telephone_number": "570-808-7920",
            "fax_number": "570-808-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CAROLYN",
        "middle_name": "TERESA",
        "name_prefix": "Mrs.",
        "credential": "RN BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN308661L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Cipoletti
• City of Wilkes Barre
• Logan T Clair, DO
• Emily Lynn Clapp, SLP
• Braxton Clark
• Karen Shepard Clark, RN, MS, CRNP, ACHPN
• Shawn Gerald Clark, D.O.
• Scott Michael Clarke, M.D.
• Margot E. Clasquin, M.D.
• Cleanslate Medical Group of Pennsylvania LLC

• Registered Nurse in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Registered Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.