Individual provider Active NPI

Mary Angelyn Joves Clark, MSN, APRN

  • Nurse Practitioner
  • Walnut Creek, CA
National Provider Identifier
1053887455
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP95009579 Issued in CA
Practice address
177 La Casa Via Ste 390
Walnut Creek, CA 94598-6101
Phone
(925) 692-5610
NPI assigned
Oct 23, 2018
Last updated
Oct 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP95009579 CA Primary
Adult Health Nurse Practitioner 363LA2200X NP95009579 CA
Family Nurse Practitioner 363LF0000X NP95009579 CA
Registered Nurse 163W00000X 95068012 CA

Addresses

Primary practice location

177 La Casa Via Ste 390
Walnut Creek, CA 94598-6101

Mailing address

1450 Treat Blvd Ste 300
Walnut Creek, CA 94597-2168
Phone (925) 952-2828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20190531000835 CA Practitioner - Nurse Practitioner 1052644382 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
John Muir Physician NetworkGroup PAC ID 6608789813, 488 clinicians
Permanente Medical Group IncGroup PAC ID 8921910225, shared by 2 NPIs, 10,928 clinicians

Practice addresses (Care Compare)

2675 Pleasant Hill Rd
Pleasant Hill, CA 94523-2033
Phone (925) 692-5520

3100 Dublin Blvd
Dublin, CA 94568-4363
Phone (925) 556-4200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95068012CAMDRegistered Nurse
NP95009579CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Albion Medical Partners of California West P C CurrentSince Feb 1, 2021 Accepting new patients
San Joaquin Faculty Medical Group CurrentSince Apr 1, 2019 Accepting new patients
County of San Joaquin CurrentSince Apr 1, 2019 Accepting new patients
Epic Care CurrentSince Feb 22, 2021 Accepting new patients
County of San Joaquin CurrentSince Apr 1, 2019 Accepting new patients
John Muir Health PastSince Oct 12, 2025 Accepting new patients
Caremore Health Plan Family PastSince Jul 8, 2019 Accepting new patients
John Muir Health PastSince Oct 12, 2025 Accepting new patients

Locations

4721 Dallas Ranch Rd
Antioch, CA 94531
Phone (925) 676-2600

12900 Park Plaza Dr
Ste 700
Cerritos, CA 90703
Phone (562) 622-2800

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

Interoperability endpoints

  • Direct secure messaging: mclark161021@ehr.johnmuirhealth.com

Organizations & group practices 9

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1053887455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 TREAT BLVD STE 300",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945972168",
            "telephone_number": "925-952-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 LA CASA VIA STE 390",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945986101",
            "telephone_number": "925-692-5610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY ANGELYN",
        "middle_name": "JOVES",
        "name_prefix": "Ms.",
        "credential": "MSN, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-23",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP95009579",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "NP95009579",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95009579",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95068012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.