Alexis Mikayla Clark, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-943 Issued in AR

Practice address

1438 E Augustine LN Ste 2
Fayetteville, AR 72703-5462

Phone

(479) 335-5777

NPI assigned

Oct 16, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Alexis Jones Former name

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Roller Weight Loss Institute,Inc.

  • Specialist
  • Fayetteville, AR
  • NPI 1073743399
  Medicare reassignment
• Roller Weight Loss Institute Inc

  • Surgery Physician
  • Tulsa, OK
  • NPI 1912446741
  NPD

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1053919563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1438 E AUGUSTINE LN STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035462",
            "telephone_number": "479-335-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 E AUGUSTINE LN STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035462",
            "telephone_number": "479-335-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ALEXIS",
        "middle_name": "MIKAYLA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-16",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "JONES",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hailey Belle Chufar, LAT, ATC
• David A Churchill
• Cip, Inc
• Jennifer Lee Clampitt, RD LD
• Alan Douglas Clark, DDS
• Brittany Clark
• Caitlin Clark
• Calvin Clark, LAC
• Christine R Clark, RD, LD, CDE
• Donita J Clark, R.D., L.D.

• Physician Assistant in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.