Jacqueline Clarke, RN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

5015199 Issued in NC

Practice address

2910 Haig St
Greensboro, NC 27405-3391

Phone

(336) 314-4384

NPI assigned

Jul 30, 2021

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 NC

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physiatry Consultants of NC PLLCGroup PAC ID 2567871643, 77 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

Practice roles

Locations

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.

• Physiatry Consultants of NC PLLC

  • Physical Medicine & Rehabilitation Physician
  • Morton Grove, IL
  • NPI 1437736881

  NC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1043983489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 HAIG ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274053391",
            "telephone_number": "336-314-4384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 HAIG ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274053391",
            "telephone_number": "336-314-4384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "JACQUELINE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5015199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryonna Lanae Clark
• Sherry L. Clark, N.P.
• Timothy Clark, DC
• William D Clark, MD
• Daniel Clarke-Pearson, MD
• Leah Clarke, MS, NCC
• Nettie Rose Clarke, MS., CRC., LPC.
• Za'Myria Clarke
• Classic Care Family Services II LLC
• Classic Care Family Services Inc.

• Gerontology Nurse Practitioner in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Gerontology Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.
• 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.