Jodi L Clark

Individual provider Active NPI Attendant Care Provider · Tennessee Ridge, TN

NPI 1043348634 · NPPES record last updated Jul 8, 2007

Key facts

NPI: 1043348634
Entity type: Individual (NPI type 1)
Primary specialty: Attendant Care Provider 3747A0650X
Practice address: 1330 N Main St
Tennessee Ridge, TN 37178-4003
Phone: (931) 721-3312
NPI assigned: Mar 2, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Centerstone of Tennessee, Inc. Mental Health Clinic/Center (Including Community Mental Health Center) · Manhattan, KS · NPI 1023900651

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Centerstone of Tennessee, Inc.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Attendant Care Provider	3747A0650X			Yes

Addresses

Primary practice location

1330 N Main St
Tennessee Ridge, TN 37178-4003

Mailing address

90 Metcalf Dr
Erin, TN 37061-5010
Phone (931) 289-4808

Other providers in Tennessee Ridge, TN

All providers in Tennessee Ridge, TN · Attendant Care Provider in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.