Claudette Vivienne Clark, MSN,RN,CPNP,IBCLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

1-059903 Issued in AL

Practice address

3851 Roger Brooke Drive
Brooke Army Medical Center
Fort Sam Houston, TX 78234-6200

Phone

(210) 916-9233

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053457135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 DICKMAN RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782342604",
            "telephone_number": "210-595-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DRIVE",
            "address_2": "BROOKE ARMY MEDICAL CENTER",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782346200",
            "telephone_number": "210-916-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CLAUDETTE",
        "middle_name": "VIVIENNE",
        "name_prefix": "Mrs.",
        "credential": "MSN,RN,CPNP,IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AL",
            "license": "1-059903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yun Chung
• Adam Church, DSC, PA-C
• Theodore John Cieslak, M.D.
• Ricardo Cisneros, CPHT
• Caroline Claassen, OTR/L
• Bradley Cole Clarkson, PHARMD
• Beverly Dale Clay
• Conner Joseph Clay, MD
• Sarah Icyline Clayton, LCSW
• Michael Neill Clemenshaw, M.D.

• Primary Care Clinic/Center in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.