Active NPI
Kathleen Marie Clark, MSN FNP C
- Nurse Practitioner
- Long Beach, CA
National Provider Identifier
1083774582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 16395
- Practice address
- 1250 Bellflower Blvd
SHS
Long Beach, CA 90840-0201 - Phone
- (562) 985-5146
- Fax
- (562) 985-8404
- NPI assigned
- Dec 12, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 16395 | CA | Primary |
Addresses
Primary practice location
1250 Bellflower Blvd
SHS
Long Beach, CA 90840-0201
Mailing address
3247 Chatwin Ave
SHS
Long Beach, CA 90808
Phone (562) 354-6083
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
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16395 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083774582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3247 CHATWIN AVE",
"address_2": "SHS",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90808",
"telephone_number": "562-354-6083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 BELLFLOWER BLVD",
"address_2": "SHS",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908400201",
"telephone_number": "562-985-5146",
"fax_number": "562-985-8404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "MSN FNP C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "16395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- 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.