Active NPI
Kathryn A Clark, PHARM D
- Pharmacist
- Fernandina Beach, FL
National Provider Identifier
1073895686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS41394
- Practice address
- 2101 Sadler Rd
Fernandina Beach, FL 32034-4452 - Phone
- (904) 277-9615
- Fax
- (904) 261-4838
- NPI assigned
- Sep 9, 2011
- Last updated
- Sep 9, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS41394 | FL | Primary |
Addresses
Primary practice location
2101 Sadler Rd
Fernandina Beach, FL 32034-4452
Mailing address
2101 Sadler Rd
Fernandina Beach, FL 32034-4452
Phone (904) 277-9615
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS41394 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315526400000",
"number": "1073895686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 SADLER RD",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320344452",
"telephone_number": "904-277-9615",
"fax_number": "904-261-4838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 SADLER RD",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320344452",
"telephone_number": "904-277-9615",
"fax_number": "904-261-4838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KATHRYN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-09",
"last_updated": "2011-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS41394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fernandina Beach, FL
- Michelle Christie
- Sharon Ann Chunn, LMHC, LPC
- City of Fernandina Beach (City of Fernandina Beach Fire Rescue)
- Clarity Professional Hearing Aid Center
- John D Clark, M.D.
- Coastal Community Health Services, Inc.
- William Harmon Andrew Collins, R.PH., D.PH., P.D.
- Compassion4U Care Management, PLLC
- Complete Psychiatric Care
- Concierge Care of Amelia Island, LLC (Concierge Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.