Individual provider Active NPI

Toni Clark, RN, MS, CFNP

  • Nurse Practitioner
  • Alice, TX
National Provider Identifier
1003833559
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
576086 Issued in TX
Practice address
2500 E Main St
Alice, TX 78332-4169
Phone
(713) 456-5000
NPI assigned
Jul 17, 2006
Last updated
Feb 19, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 576086 TX Primary

Addresses

Primary practice location

2500 E Main St
Alice, TX 78332-4169

Mailing address

PO Box 849881
Dallas, TX 75284-0001
Phone (866) 916-5259

Other identifiers 1

IdentifierTypeStateIssuer
P083N0230MedicaidTX

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)
Enrolled
Credentials
Master of Science, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
57908TXMDProfessional Counselor
576086TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bayside Emergency Pyhsicians, LLP Nurse Practitioner Past Accepting new patients
Memorial Southeast Emergency Physicians, LLP Nurse Practitioner Past Accepting new patients
Bayside Emergency Physicians, LLP Nurse Practitioner Past Accepting new patients
Memorial Southwest Emergency Physicians, LLP Nurse Practitioner Past Accepting new patients
Memorial Northwest Emergency Physicians, LLP Nurse Practitioner Past Accepting new patients
Memorial City Emergency Physicians, LLP Nurse Practitioner Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203379200000",
    "number": "1003833559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849881",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840001",
            "telephone_number": "866-916-5259",
            "fax_number": "231-922-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E MAIN ST",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783324169",
            "telephone_number": "713-456-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TONI",
        "credential": "RN, MS, CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "576086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P083N0230",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alice, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; 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.