Theresa S. Clark, MSRD,C.D.E., L.D.

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

KY-0517 Issued in KY

Practice address

530 Noel Ave
Hopkinsville, KY 42240-1386

Phone

(270) 707-0060

Fax

(270) 707-0068

NPI assigned

May 7, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary G Spencer, M.D.

  • Family Medicine Physician
  • Hopkinsville, KY
  • NPI 1740282714
  Medicare reassignment

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

• Clark & Powell Associates, LLC

  dba Diabetes Resource Center Of Hopkinsville

  • Registered Dietitian
  • Hopkinsville, KY
  • NPI 1700161916

  Dietitian, Registered

  NPD (past) Authorized official

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470355200000",
    "number": "1013120948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NOEL AVE",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422401386",
            "telephone_number": "270-707-0060",
            "fax_number": "270-707-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NOEL AVE",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422401386",
            "telephone_number": "270-707-0060",
            "fax_number": "270-707-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "THERESA",
        "middle_name": "S.",
        "name_prefix": "Mrs.",
        "credential": "MSRD,C.D.E., L.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2016-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "KY",
            "license": "KY-0517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID NO.",
            "identifier": "38364492",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE DIETITIAN",
            "identifier": "KY-0517",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000505900",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chanda N Clark
• Dustin Ryan Clark
• Hope B Clark, APRN
• James Michael Clark, MD
• Sarah Lynn Clark
• Kimberly Gail Cloyd, R.D.
• Sarah Elizabeth Coats, PT
• Callie Coffey
• Holly Coffman
• Nichole Suzanne Cokrlic, CSW

• Registered Dietitian in Hopkinsville, KY
• Providers in Hopkinsville, KY by specialty
• Registered Dietitian in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.