Kathleen a. Clark MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

P8871 Issued in TX

Legal business name

KATHLEEN A. CLARK MD PA

Practice address

5701 Time Square Blvd Ste 220
Amarillo, TX 79119-1178

Phone

(806) 350-7311

Fax

(806) 350-7361

NPI assigned

Oct 13, 2015

Organization subpart

No

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

Authorized official

Name

Kathleen Anne ClarkNPI 1518103886

Title

MD

Phone

(806) 350-7311

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southwest Anti-Aging Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kathleen Anne Clark, M.D.

  • Internal Medicine Physician
  • Amarillo, TX
  • NPI 1518103886
  Medicare reassignment Authorized official
• Christi Ann Rogers, MSN, RN, FNP-C

  • Family Nurse Practitioner
  • Amarillo, TX
  • NPI 1073091914
  Medicare reassignment NPD
• Richard H Bechtol, MD

  • Family Medicine Physician
  • Amarillo, TX
  • NPI 1780620757
  NPD (past)

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1083085385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 TIME SQUARE BLVD STE 220",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791191178",
            "telephone_number": "806-350-7311",
            "fax_number": "806-350-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 TIME SQUARE BLVD STE 220",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791191178",
            "telephone_number": "806-350-7311",
            "fax_number": "806-350-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN A. CLARK MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "806-350-7311"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "P8871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1083085385",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Anti-Aging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karim Nawaz MD PA
• Karr & Hardee Dentistry Partnership PLLC
• Karr and Hardee Dentistry Partnership
• Thomas Edmond Karr, D.D.S.
• David Alan Kastner, M.D.
• Kathryn McNeil MD, PA
• Michele Milburn Kauffman, PA
• Robert Kauffman, MD
• Kaye Renshaw, P.C., Counseling and Consultation
• Jeffery Alan Kee, PSYCHOLOGIST

• Internal Medicine Physician in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.