Marla Jo Clancy, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024180099 Issued in VA

Practice address

4041 Taylor Rd Ste G
Chesapeake, VA 23321-5525

Phone

(757) 483-6404

Fax

(757) 483-0737

NPI assigned

Sep 11, 2020

Last updated

Nov 7, 2021By the provider in NPPES

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

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marlaclancy@cpai.allscriptsdirect.net

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.

• Churchland Psychiatric Associates PC

  • Psychiatry Physician
  • Chesapeake, VA
  • NPI 1740359223
  Medicare reassignment NPD
• Riverside Physician Services Inc

  dba Churchland Psychiatric Associates

  • Psychiatry Physician
  • Portsmouth, VA
  • NPI 1821421454
  NPD (past)

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636243200000",
    "number": "1023623436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 TAYLOR RD STE G",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215525",
            "telephone_number": "757-483-6404",
            "fax_number": "757-483-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 TAYLOR RD STE G",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215525",
            "telephone_number": "757-483-6404",
            "fax_number": "757-483-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "MARLA",
        "middle_name": "JO",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-11",
        "last_updated": "2021-11-07",
        "certification_date": "2021-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024180099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Chesapeake (Chesapeake Integrated Behavioral Healthcare)
• City of Chesapeake (Chesapeake Integrated Behavioral Healthcare)
• City of Chesapeake (City of Chesapeake Emergency Medical Services)
• City of Chesapeake Ta Chesapeake Community Serv Board
• Monica Elizabeth Claiborne, CSA
• Clarity Therapeutic Strategies LLC
• Elizaveta Valerievna Clark
• James Clark, AEMT
• Nichelle Brittany Clark, IBCLC
• Olivia Clark, RBT

• Psychiatric/Mental Health Nurse Practitioner in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.