Charles Nicholson Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP139709 Issued in TX

Practice address

575 Hill Country Dr Ste 301
Kerrville, TX 78028-6024

Phone

(830) 258-7762

NPI assigned

Nov 12, 2018

Sex

Male

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peterson Medical AssociatesGroup PAC ID 1355467887, 192 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peterson Regional Medical Center Hospital, Kerrville, TX, CCN 450007

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.clark.1@21041.direct.athenahealth.com

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.

• Peterson Medical Associates

  • Obstetrics & Gynecology Physician
  • Kerrville, TX
  • NPI 1770800575
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sid Peterson Memorial Hospital

  • Rural Acute Care Hospital
  • Kerrville, TX
  • NPI 1790782704
  Care Compare affiliation

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

{
    "created_epoch": "1541980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1013485713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 HILL COUNTRY DR STE 101",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286024",
            "telephone_number": "830-258-7762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 HILL COUNTRY DR STE 301",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780286024",
            "telephone_number": "830-258-7762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "NICHOLSON",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-12",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP139709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris Williams, M.D., P.a.
• Valerian Chyle Jr., MD
• Lisa Jeannette Cisneros, LPC
• City of Kerrville
• Carol H Clark, PH.D.
• Elaine C Clements, RN
• Cloup PLLC
• Jordan Cluck, FNP-C
• Kimberly Ann Cochran, OTL
• Brian Thomas Cocke, MD

• Family Nurse Practitioner in Kerrville, TX
• Providers in Kerrville, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.