Edward Clark, LVN, LPN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

331536 Issued in TX

Practice address

6600 E Ben White Blvd
Austin, TX 78741-7537

Phone

(512) 804-3740

NPI assigned

Sep 17, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Austin Travis County Mental Health and Mental Retardation Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Austin, TX
  • NPI 1053632505
  NPD (past)
• Austin Travis County Mental Health and Mental Retardation Center

  • Psychiatry Physician
  • Austin, TX
  • NPI 1750337259
  NPD (past)

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

{
    "created_epoch": "1505606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505606400000",
    "number": "1033638424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 COLLIER ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787042911",
            "telephone_number": "512-472-4357",
            "fax_number": "512-703-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 E BEN WHITE BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787417537",
            "telephone_number": "512-804-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EDWARD",
        "credential": "LVN, LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-17",
        "last_updated": "2017-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "200930549LPN",
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "TX",
            "license": "331536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Sean Clark, LMFT
• Cory J Clark, LPC, LCDC, LMFTA
• Courtney Elizabeth Clark, DPT
• Douglas Fredrick Clark, O.D.
• Dynetta Clark, LPC-S, LPC, LMHC
• Elizabeth Clark, LPC
• Erin Clark, RDN, LDN
• Eva Clark
• Heather Clark, NP
• Jacob Zachary Clark, CRNA

• Licensed Vocational Nurse in Austin, TX
• Providers in Austin, TX by specialty
• Licensed Vocational Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2017; 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.